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A glimpse at the early BAPS
A Glimpse at the Early BAPS By C. Everett Koop Hanover, New Hampshire
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HAVE BEEN ASKED to write for this special issue of the Journal of Pediatric Surgery a personal memoir of the earlier days of the BAPS in the 50th Anniversary year of the British Association of Pediatric Surgeons. Such a memoir must indeed be personal, and it cannot be all inclusive. By anecdote, I will attempt to express some of the things that made the BAPS special to so many people, with apologies to those who will think I have not included their fondest memories of the BAPS. My introduction to the BAPS was made in person by Peter Rickham, who came to visit me at the Children’s Hospital in Philadelphia in 1954. By that time, I had been at work in pediatric surgery in the city of Philadelphia for 8 years. Peter spoke in such glowing terms of the meetings of the British Association of Pediatric Surgeons—the BAPS—that it seemed imperative that I attend a meeting as soon as I could. Fortunately, an International Pediatrics Meeting was held in Copenhagen in 1956, and it seemed sensible to attend both the BAPS in London followed immediately by the International Pediatric Meeting in Copenhagen. It was also my first trip to the United Kingdom, where they were understandably a lot slower regaining their prewar status than the United States. So, going to London was like stepping back a decade, and going to the BAPS was to me like entering a fantasy land that I never even thought might exist. First, in the early days, even with their visitors, the meetings of the BAPS were not large congregations of surgeons. With the small numbers, it was possible to use a different format than we were accustomed to even in those days—large numbers of surgeons, too many papers, and not much time for any. The exchange of information was at the highest level of any I have experienced in the meeting of any medical society before or since. In any given half day, we discussed no more than 2 subjects. The first subject on the agenda in 1956 was portal hypertension. A regular member of the BAPS made an opening statement of not more than 5 minutes, From the C. Everett Koop Institute, Dartmouth Medical School, Hanover, NH. Address reprint requests to C. Everett Koop, MD, ScD, Elizabeth DeCamp McInerny Professor of Surgery and Senior Scholar at the C. Everett Koop Institute, Dartmouth Medical School, Hanover, NH 03755-3862. © 2003 Elsevier Inc. All rights reserved. 0022-3468/03/3807-1005$30.00/0 doi:10.1016/S0022-3468(03)00072-1 20
hitting the highlights of the problems in diagnosis and therapy of portal hypertension, as well as the several etiologies that led to that diagnosis. Then a responder covered the things that the presentor had not hit for about 2 more minutes. From then on, for half of the morning or afternoon there was a free-for-all discussion as we told our personal stories of triumphs and defeats in the management of this most difficult pediatric affliction. With a name like Koop, I found names of other attendees to be much more substantial. Clatworthy (William C. from Columbus, Ohio) I had known from training days at Boston Children’s Hospital. C.C. Winkel Smith from Denmark, T. Twistington Higgins from London, Albert Oberniedermayer of Munich, Germany were names to be reckoned with. Winkel Smith was a kindly, affable surgeon who seemed to have considerable experience in most everything in the surgical problems of children. He was beloved by all, and it was difficult eventually to face the fact that several years after that meeting his car was found on the shores of a lake with the driver’s door open; he was never seen again, only to be declared “death by suicide” some years later after an anxious family gave up ever seeing him again. Albert Oberniedermier from Munich, Germany was not only a name to be reckoned with, but also Germanic in behavior of a previous day. Two young surgeons always accompanied him as dieners. He had the attractive habit—at least in the beginning— of smartly clicking his heals at the end of every introduction or when he left your company to move elsewhere. Denis Browne (DB) who had been the chief of surgery at the Hospital for Sick Children, Great Ormond Street was considered to be the father of pediatric surgery in the United Kingdom. He was our only member knighted by the Queen (although we all thought David Waterston should have been after taking out a juvenile royal appendix.) We expected from him, not only the wisdom and skill that went with his professional position, but also the behavior one would expect from the peerage. His capable and lovely wife accompanied him to all BAPS meetings and was eventually made a member. The aforementioned surgeon (DB) of the skin and all of its contents did a lot of procedures that were orthopedic in nature, which most American pediatric surgeons did not. Pediatric orthopedics, if it could be called that, was established before general pediatric surgery was in the United States and remained a special area of surgical interest that most later pediatric surgeons did not pracJournal of Pediatric Surgery, Vol 38, No 7, Suppl 1 (July), 2003: pp 20-26
A GLIMPSE AT THE EARLY BAPS
tice. One of the things DB was famous for was the Denis Browne splint used for congenital dislocation of the hip. It was an astonishing sight in the vicinity of Great Ormond Street, to see children coming by way of public transportation wearing Denis Browne splints, which kept them in a squatting position as they managed their locomotion looking very much like waddling ducks. As meetings grew larger, Sir Denis Browne was always prepared to be a discussant of almost everyone else’s presentation at a formal meeting. He seemed insensitive to the feelings of younger surgeons and their nervousness at presenting a paper in his presence, and he was not particularly kind to them if (when!) he disagreed with them. One of his techniques was to sit as a member of the audience, frequently with Lady Moyra at his side, open a collapsible lapboard and put it across his legs. He then laid out a large collection of slides on the subject about to be presented. As the presenter covered specific things Sir Dennis thought were important to the total presentation, he would pick the appropriate slide from his lapboard and put it back in the box. Eventually, as the presenter wound down his 10-minute presentation, there would only be 3 or 4 slides left out of perhaps 20. Sir Dennis would then take these to the projectionist and fill in all the blanks that he felt had been left out, even though he frequently strayed beyond the narrow confines of the title of the paper. Lady Moyra was a striking, handsome woman. Befitting her title, she always seemed a little austere to me, although we did formally bow in recognition of each other when we met. In the first year that the BAPS met at Manchester, on the last evening before the preprandial sherry, I was in black tie, standing in the front row of passengers in a crowded elevator, with a number of distinguished international pediatric surgeons behind me descending to the lobby floor. We stopped at an intervening level, the doors opened laterally, and Lady Moyra, dressed in suitable finery for the formal dinner, stepped onto the elevator into the small space that was left between the closing doors and me. She turned around, as is the custom to face the front, and as she did so, I was probably the only person in the elevator who could see that in zipping up her evening gown she had actually torn the zipper from the cloth on one side as she zipped from bottom to top. I didn’t have much time to decide how this should be handled, and being a little nervous how Lady Moyra might react to my first impulse, I nevertheless placed one hand on her shoulder and said, “Lady Moyra, I’m going to stand very close to you and let’s walk together across the room to the nearest wall; then you turn your back to the wall, and I will tell you why I am doing this.” Fortunately, without argument she complied, and we made our way to the nearest corner and I explained what I had seen. She then reached around
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to her back and gave a huge audible gasp when her hand encountered bare back instead of brocade. I suggested that she stay as she was and I would go find the necessary things to repair the difficulty and make her presentable for the evening. Fortunately, the concierge was able to find me a little box of miniature safety pins and as though I were inserting subcuticular stitches, I pulled Lady Moyra’s gown and the cloth attached to the zipper into proper juxtaposition so that only the most thorough inspection would have revealed the former problem. Thereafter, Lady Moyra and I were close friends, and we never mentioned the incident again, but my wife and I were the recipients of several invitations to their home and we were visited on one occasion in Philadelphia by her son. It is the opinion of this writer that the BAPS itself, and international pediatric surgery in general, owe a tremendous amount to Peter Rickham. He may not have been the official officer to do the job, but no one tried harder to solidify international pediatric surgery than he did, and no one had a better flair for bringing surgical strangers together, introducing a subject, and making them all sharing surgical colleagues and friends for life. Peter Rickham was also one of the most unconsciously funny men that I have ever known. Not only did he do things that were extraordinarily funny, but he recounted incidents in his life, usually brought about by his own failure to do something on time or not at all, and in poking fun at himself, described so intricately and vividly personal experiences, that one felt he had lived through them with Peter. Peter and I became fast friends from the time he first visited me in Philadelphia, and he came back more than once to stay with us; Betty and I were houseguests of Peter and Elizabeth in Liverpool on several occasions. One time when I was visiting Alder Hey Children’s Hospital in Liverpool without Betty and was staying with Peter, he drove me to work every morning through the Mersey Tunnel. In the United Kingdom, cars then had cranks still attached to the crankshaft protruding from the bottom of the radiator to start the engine by hand if the electric starter failed. This was long after we had abandoned such accoutrements on American cars. One day when Peter was driving me to the hospital for a day in the operating room his car stalled at one of the places in the Mersey Tunnel where the tunnel divides into 2 possible paths. We blocked a long line of traffic behind us, unable to move. Peter, brushing aside all my offers to help, ran out. cranked the car, was unsuccessful, ran back and advanced the spark, repeated the procedure, ran back and advanced the throttle, and repeated the procedure. He must have done this 6 or 8 times before the engine finally sputtered, caught, and we drove away accompanied by honking horns behind us. It is not a scene that ordinarily would have caused me laugh, but the manner in which
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Peter tried to manage the crank, the spark lever, and the throttle, could not be viewed without, not just laughter, but almost hysterics. If you saw it on television, you might say it was over done. Another time when Betty and I were staying with them, Peter told a very plaintive tale about how as a Swiss, he could not stand one more year of heating his home in Liverpool with multiple coal fires in open fireplaces and had installed central heating. He could not believe that his neighbors felt he was not showing the stiff upper lip in cold weather, expected of a true Brit and was almost ostracized. There was another incident that wasn’t funny in itself, but was extraordinarily humorous watching Peter take it all in and finally come to an understanding of what happened. Peter’s wife Elizabeth was a marvelous cook and a great party giver. She had invited a select, but rather large number of the BAPS members to have a buffet supper at their home at the height of the strawberry season. There was a huge punchbowl filled with strawberries much larger than we saw in America at that time. Since then, we seem to have learned the trick of growing them. Next to the strawberries, she had a mountain of whipped or clotted cream. The cream was so high in butterfat that it was actually yellow in color and looked more like mayonnaise than it did like whipped cream. As a result, the guests devoured the strawberries, but never dipped them in the cream as the hostess had intended. After the guests had left, when Peter finally figured it all out, he went into the kitchen and brought another bowl of strawberries and he and I devoured those taking more than ample servings of the yellow cream on each strawberry—not only delicious, but probably contributed to the high blood cholesterol we both eventually had to control. If Peter Rickham served the purpose I have described as the public relations representative for the BAPS, it was Bob Zachary of Sheffield who never let us down with his ability, each year, to outdo his performance at the previous meeting. During some creative time when he was younger and an invalid, Bob had learned some Slavic languages. I believe his mother was Czechoslovakian. He apparently had a flair for learning languages, and I remember at the meeting in 1956 he gave a toast and addressed each foreign member present in that person’s native tongue. And so it went year after year, until he was the host of the meeting in Sheffield in the year that John Holter received an honorary degree from the University of Sheffield for his development of the Holter valve for use in hydrocephalic shunts. On that occasion, the foreign contingent was huge and represented, as I recall, about 50 different countries. Somehow or other, in a very lengthy welcome, Bob managed to say something in each language represented there, although there were
C. EVERETT KOOP
those unkind enough to criticize his pronunciation of some of the more esoteric ones. But a good show it was. Bob was always the first on the dance floor at the final formal dinner dance each year, and an orthopedic problem with his upper spine, which was a spin-off from his encounter with Pott’s disease in his youth, never kept him from doing rather amazing dancing, which included the latest fad no matter how the intricate the gyrations might be. My recollection of the first meeting is still very vivid, and not only did I enjoy immensely the scientific part of the program, but the social portion of the gathering could never be duplicated in the United States. I recall that our final, formal black tie dinner was held at the Apothecary’s Hall. Not only is this an historic building in London with absolutely gorgeous interior decorations, but it is in an out-of-the way spot in that city of streets that don’t run at right angles to each other. It was the only time in my life that I’ve ever given directions to a London cabby when he didn’t know how to get there. Not only that, but he had to inquire of 3 other cab drivers before he found one who guided us through a maze of tiny streets to our intended destination. The sherry party, which proceeded the extremely formal meal, was also formal with 5 wines, but the protocol of announcing the speakers was again something that Americans are not accustomed to and which, unfortunately, as the BAPS meetings got larger and larger, disappeared from their protocol as well. There was a beadle, properly dressed, carrying a mace of prodigious size. He announced the president of the BAPS and dropped the mace to the floor with a resounding thump. Before he announced the second speaker, he mentioned the name of the first; before he announced the third speaker, he announced the names of the first and second; before he announced the name of the fourth speaker, he announced the names of the first, second, and third, and so on. This formality, the uniqueness of the venue and the protocol, all being part of my first trip to the United Kingdom, left such an indelible impression on my mind that I think those hours in the Apothecary’s Hall are still the memory that comes to my mind when I hear someone mention the BAPS. The custom of the BAPS was to alternate venues of the annual meetings between London and some other city in the United Kingdom, and then the BAPS began every few years to choose a foreign venue on the invitation of the host who had become a familiar figure at preceding BAPS meetings. The first was in Stockholm and the second in Rotterdam. David Vervat, the chief of pediatric surgery at the Children’s Hospital of Rotterdam, one of the oldest in Europe, was the host. We all came from so many different far away places that it was not unusual for a number of us to arrive fairly early in the
A GLIMPSE AT THE EARLY BAPS
day preceding the opening of the meeting. The morning of the first day was used for meetings of the council, the executive committee, etc, followed by a luncheon; the scientific meeting began after lunch. On this occasion, there must have been 12 of us who were in Rotterdam on Sunday with no specific plans until Monday noon. David took us out on his very seaworthy sloop for a sail, not only in Rotterdam harbor, but into open water as well. He, with his Dutch friends, was dressed appropriately for the captain of a sizeable sailing yacht, but most of us did not come to the BAPS prepared for such enjoyable leisure time activity and were without appropriate clothes. I felt particularly out of place; I had made the Atlantic crossing safely, but my baggage had not accompanied me. I was dressed in my travel clothes, which, in those days, were much more formal than the more grungy apparel people wear for such travel these days. The second memorable event at that meeting was an audience with Queen Juliana of the Netherlands in her gardens in Amsterdam. David Vervat selected a delegation for the royal meeting consisting of a single representative of a number of countries and the officers of the BAPS, all United Kingdom. I don’t think any of us had been this intimately involved in something as unusual as tea with the Queen, except for Sir Denis Browne, who had already been knighted in the United Kingdom. We naturally looked to him to carry the ball in conversation, but he, for some reason seemed disinclined. Before meeting the Queen, we had all been taken into a side room of the palace and given instructions about when to stand, when to sit, and how long to stay. We even had the crease in our trousers examined. Isabelle Forshall was the only woman in our delegation, and a worthy representative she was; indeed, she was the grand dame of the BAPS membership. Inasmuch as, Sir Denis didn’t take up the initiation of conversation for us and the pause became awkward. I finally came up with something and asked: “Your Majesty, do you remember going into the village of Rijns Atervoude several years ago, walking across the dike and greeting one of your subjects on the morning of her 100th birthday? She was an old friend of mine.” That broke the ice, the Queen said she tried to do that when anyone among her subjects reached the century mark and the conversation flowed freely from then on. We made no faux pas that I know of, left at the right time, but never figured out what it was she carried in that large handbag that she kept close to her feet. The third thing that was interesting about the trip to Rotterdam was that David Vervat had arranged for those who wished to go by train to Leiden to look at the Siemens factory where they made x-ray machines that were widely used in Europe at that time and are now used in America as well. There a pleasant time of fellowship
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on the train and a lot of the conversation had to do with whether there should be, in addition to the BAPS, which served as the international gathering for pediatric surgeons, an additional international society with its own title and its own international agenda. Somewhat reminiscent of things we’d heard about such as treaties being signed in railroad cars in World War I, a group of us made our way through the train into the baggage car, pulled over various objects we found there, used them for chairs and a large box for a table. It was there that the International Society of Pediatric Surgery was born. One of the things I did for many years at the BAPS meetings was to take candid Minox photographs of 2or 3 members together and send a picture of each person photographed in a little folder as a Christmas card saying, “You have been Minoxed.” All of those pictures that I could find in the past several years I’ve passed on to the BAPS to become part of their archives. Of all the presidents of the United States that were in office during my years of association with the BAPS none captured the fancy of Europeans as did John Kennedy. I remember the pleasure of many in the year that the Kennedy half-dollar was first minted, when I brought as many as I could conveniently carry in several pockets and passed them around to friends usually after I’d snapped their Minox picture. There were 2 guests that came to the BAPS meeting very frequently, that we not only looked forward to meeting again, but for whom we had concern, because of the prevailing political climate of the countries from whence they came. One of these was Vaclav Kafka from Prague and the other was Stayslav Doletzky from Moscow. Kafka was beloved by all, because of his political courage as well as his broad experience in pediatric surgery and his ability to explain it in excellent English. But we all knew that while he was at our meeting, his family was under house arrest until he returned, so fearful was the government that his outspoken opposition to the communist regime might sometime cause him not to return to Czechoslovakia. We all felt the same tensions he did, particularly if the day of his departure was a stormy one and he might face the difficulty of arriving late because of weather interfering with the airline schedules. To my knowledge, he always made it in time, but it was his courage in coming to be with us at great personal sacrifice and share our concerns about children’s surgery that endeared him to us all. Doletsky didn’t have the problem of having his family under house arrest, but he had a more difficult problem of being accompanied by one or 2 members of some police agency of the Soviet Union who kept their eyes on him at all times. He and I had our private conversations in the men’s room. I remember one occasion when I, acting as editor of the Journal of Pediatric Surgery, had told
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Doletsky I would return some pictures I was not going to use in an article of his that we would publish, and would do so when I saw him at the BAPS meeting. I carried them with me in a large manila envelope and handed him the envelope in front of 20 or 30 people. Because he was under the scrutiny of his keepers, it was sad to see Doletsky open the envelope, take out the 3 pictures, turn each one so they could see both sides of the photograph, then turn the envelope upside down to show them it was empty, and redeposit the pictures before clipping the envelope together. Someplace along the line, Doletsky, who played the piano very well, had learned American jazz. Many a time, either at someone’s home the night before the meeting began, or perhaps late after a formal dinner was over, a number of us would gather around the piano and sing songs I would never have thought Doletsky, living the monitored life he did in the Soviet Union, would have known. The only thing I ever saw him doing out of keeping with the personality I had come to know happened one night at the Liverpool meeting when we were all on the Mersey River in an excursion boat eating fish and chips; Doletsky came to Steve Gans and said, “Steve, let us exchange pens, so that we can have them as a memory of each other.” Steve, of course, was delighted and took a very expensive mechanical ballpoint pen out of his pocket; I think it was a Cross Pen— gold plated or better— which Doletsky pocketed. He then reached into his breast pocket and gave Steve his BIC. Years after, while I was Surgeon General of the United States, I was sent by the United States to Moscow after Gorbachev’s first visit to President Reagan in Washington, to rework the Health Agreement between the Soviet Union and the United States, which had over the years fallen into disuse. That part of my trip went well, and its sequelae are really part of another story. However, while in Moscow, I tried to reach Doletzky, which immediately attracted the attention of my hosts. I was informed formally, not by health officials, but people I assumed to be part of the Secret Police, that Doletzky was seriously ill in a hospital and could not be visited. Subsequently, I wrote Doletzky in as guarded terms as I could so that he would understand that I had been in Moscow and had tried to reach him. He responded through a German intermediary, whom we had used for communication previously, and told me that he had been in Moscow, physically fit all the time I was there, and would have been delighted to see me. Another interesting incident took place while I was Surgeon General and representing the United States at an International Congress on Aging in Vienna at the same time the BAPS was having its annual meeting as guests of the Viennese Pediatric Surgeons. My wife, Betty, had
C. EVERETT KOOP
accompanied me on this occasion. Unfortunately, her luggage had never arrived, nor did it until a month after our return home. But, there were sufficient number of BAPS wives from the United States attending the meeting who gladly shared their clothing with Betty so that no one would have known she was in this awful predicament of being without her luggage. These acts of kindness by Betty’s friends were much appreciated. We had tried to buy her some clothing in Vienna, but everything Betty tried on fell off of her. She was several sizes smaller than the typical Austrian at that time. To my great surprise, I was elected to the Council of the BAPS, which I considered to be one of the greater honors that have come my way. I served in that capacity as the first American member, and I think my initial term was extended several times to at least 8 years. As an anglophile with at least 2 lines of British ancestry in my forebears, being a Council Member was a role I thoroughly enjoyed. I made fast friends, most of whom visited us in our home in Penn Valley in the Philadelphia suburbs over those and ensuing years. I gave a dinner for my closer friends among the UK BAPS members at the Athenian Club in London shortly before I became Surgeon General. Then in 1981, in the spring of the year I was due to retire, my colleagues in Philadelphia said a formal farewell to me by having a 2-day surgical meeting followed by a final banquet. I was deeply touched that representatives from about 30 countries, all members of the BAPS, came to that affair. In a sense it was the end of my formal relationship with the BAPS, because although I had attended almost every meeting from 1956 until 1980, the rigors of my role as Surgeon General of the United States kept me from active participation around the meetings of the BAPS, which I sorely missed. On one occasion when I gave a lecture on the history of Pediatric Surgery to the American Pediatric Surgical Association in New Orleans, I called attention to the fact that several countries had difficulty in convincing their own surgical community that pediatric surgery was worth special recognition, if not board status. I pointed out that each country eventually relied on someone from another country to make the point with the surgical powers that be. It was rather in line with the biblical admonition that, “A prophet is not without honor save in his own country.” Just as Harvey Beardmore, a Canadian, was so effective in getting recognition for pediatric surgery in the United States, I played a similar role in the United Kingdom, making impassioned presentations before representatives of the Royal College of Surgeons of London as well as the Royal College of Surgeons of Edinburgh. Probably because of that, my British friends nominated me for a Doctor of Medicine, Honoris Causa from the University of Liverpool in 1968. The honorary de-
A GLIMPSE AT THE EARLY BAPS
gree was bestowed, and a grand affair it was. The citation, however, was embarrassing because it was so far from the truth. In short, according to the citation that was read on the occasion, Eisenhower could never have invaded Europe without me. It wouldn’t be possible to recall to memory all of the remarkable times I had in association with the BAPS, but certain things come to mind that are so indelibly impressed in my memory that I feel they should be mentioned. At the Edinburgh meeting some of the BAPS guests were transported to the bed and breakfast lodgings by rowboats because of the flooding. I remember arriving in Sheffield the one night before the BAPS began and being given a key to my dormitory room. It was pitch black, and no switch that I turned on produced electric light. It finally dawned on me that in those days such rooms are equipped with meters requiring a shilling deposit to get electricity for the next period of time. The question was how to find a shilling, which I obtained from a passerby on the University grounds, and after that to find the meter. This took a good 15 minutes on my hands and knees in the dark until I finally found it in the corner of a clothes closet; a flood of light from all the switches I had left on rewarded the sound of the dropping coin. Once when the BAPS met in Liverpool, I was asked to appear on television in a panel discussion, which went on for about an hour. It was a hot humid day, the room was not air conditioned, and the heat from the klieg lights used in those days was intense. I sat for the interview in a 3-piece suit and, at the close, was drenched with perspiration. My tuxedo for the banquet that night was in a suitcase in Peter Rickham’s office, but I was loath to change my clothes without taking a shower, which was not available. Peter Rickham, innovative as usual, took me down to a room outside the Burn Unit of the Alder Hey Children’s Hospital and ran me a tub that was used for bathing burned children. He said I looked so refreshed after this bath that Andrew Laird, my first Scottish friend in the BAPS followed suit. Then there was the meeting in Marseilles with Michel Carcassonne as the host of an extraordinary lavish social event, which went well on into the late hours of the evening. This was followed by some high jinks by some of the younger attendees who found their antics not to the liking of the Marseilles police and ended up in jail. Michel Carcassonne personally bailed them out in the hours just before dawn. Another feature of that meeting was the (?) misprint by the then secretary indicating that Michel had organised the meeting “on the whores of the Mediterranean.” The meeting in Warsaw was the first time the BAPS ventured behind the Iron Curtain for a meeting. It was a double affair, which had started in Sheffield, and then we
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all flew en masse to Warsaw. At our very first luncheon, in a long refectory, almost immediately after landing, Michel Carcassonne was seated next to a beautiful Polish lady dressed in a skin-tight white wool sheath. As the waiter leaned over her shoulder to serve her a bowl of borscht, his tray tipped and the white dress turned red. She jumped from the table, flounced out of the room, and disappeared. Michel Carcassonne, ever the gentleman, followed to see if he could be of help and finally found her standing in the kitchen stark naked washing her white dress in a sink. That was the only time a naked woman was seen at the BAPS, but it reminds me of a luncheon at a Riviera resort at the Marseilles meeting, where we found ourselves at a topless beach, which included a topless cafeteria, where we ate to the surprise and delight of the adolescent boys accompanying their parents to the BAPS meeting. Even leaving out my American confreres, (except Steve Gans who did so much to put the Journal of Pediatric Surgery on the map) I wish there were time and space to add further references to Max Grob, David Waterston, Matti Sulamaa, Theodore Ehrenpreis, Innes Williams, Douglas Stephens, Fitz Rehbein, Jan Louw, Andrew Wilkinson, Harold Nixon, R.N. Howard, Morio Kassai, Olaf Knutrud, Barry O’Donnell, John Scott, Jim Lister, Ranmniklal Gandhi, Durham Smith, John Atwell, and Dan Young; to add some of the early Scottish members, Wallace Dennison, John Aitken, Jimmy Mason Brown, Fred Robarts, Ian Kirkland, and Rosamund Mackay; then of course Joseph Cohen, Duncan Forrest, Ed Guiney, Harvey Beardmore, Sid Cywes, Gunnar Grotte, Waldemar Hecker, Irene Irving, Peter Jones, Alexander Livadatis, Wolfgang Maier, Carlo Montagnani, Nate Myers, Sam Nissan, Denys Pellerin, Kerijiro Suruga, Peter Wurnig, and almost countless others. They were all competent surgeons, many of them were pioneers who experienced what the first few of us in any locality did, which is anything from skepticism to hostility from the established surgical culture. Yet, of one thing I am certain, all the members of the BAPS I met and whose friendship I cherished, were people who were in the field of pediatric surgery because they wanted to see children given better care and deeper understanding than was previously available to them in a surgical world dominated by adult patients whose priorities came first. The BAPS had a tremendous beneficial affect on the growth of pediatric surgery in the United States. That influence, with the establishment of the Surgical Section of the Academy of Pediatrics in 1948, the founding of the American Pediatric Surgical Association in 1970, and the ratification of the Journal of Pediatric Surgery as the
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official journal of the BAPS enabled the American specialty of pediatric surgery to reproduce in 35 years what it had taken general surgery to do over approximately 200 years. The BAPS, in 50 years, has come from a small coterie of people with a sincere desire to improve the welfare of children in surgery, who knew each other, worldwide, by their first names, to a preeminent organi-
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zation that has provided a home for international pediatric surgery. In this, the 50th Year of the BAPS, I raise a virtual glass to toast the BAPS, as I have so many times in reality at their annual meetings, to thank them for a job well done, for the inspiration they have provided to so many, and especially for their accomplishments that have benefited countless children and their families.
I
HAVE BEEN ASKED to write for this special issue of the Journal of Pediatric Surgery a personal memoir of the earlier days of the BAPS in the 50th Anniversary year of the British Association of Pediatric Surgeons. Such a memoir must indeed be personal, and it cannot be all inclusive. By anecdote, I will attempt to express some of the things that made the BAPS special to so many people, with apologies to those who will think I have not included their fondest memories of the BAPS. My introduction to the BAPS was made in person by Peter Rickham, who came to visit me at the Children’s Hospital in Philadelphia in 1954. By that time, I had been at work in pediatric surgery in the city of Philadelphia for 8 years. Peter spoke in such glowing terms of the meetings of the British Association of Pediatric Surgeons—the BAPS—that it seemed imperative that I attend a meeting as soon as I could. Fortunately, an International Pediatrics Meeting was held in Copenhagen in 1956, and it seemed sensible to attend both the BAPS in London followed immediately by the International Pediatric Meeting in Copenhagen. It was also my first trip to the United Kingdom, where they were understandably a lot slower regaining their prewar status than the United States. So, going to London was like stepping back a decade, and going to the BAPS was to me like entering a fantasy land that I never even thought might exist. First, in the early days, even with their visitors, the meetings of the BAPS were not large congregations of surgeons. With the small numbers, it was possible to use a different format than we were accustomed to even in those days—large numbers of surgeons, too many papers, and not much time for any. The exchange of information was at the highest level of any I have experienced in the meeting of any medical society before or since. In any given half day, we discussed no more than 2 subjects. The first subject on the agenda in 1956 was portal hypertension. A regular member of the BAPS made an opening statement of not more than 5 minutes, From the C. Everett Koop Institute, Dartmouth Medical School, Hanover, NH. Address reprint requests to C. Everett Koop, MD, ScD, Elizabeth DeCamp McInerny Professor of Surgery and Senior Scholar at the C. Everett Koop Institute, Dartmouth Medical School, Hanover, NH 03755-3862. © 2003 Elsevier Inc. All rights reserved. 0022-3468/03/3807-1005$30.00/0 doi:10.1016/S0022-3468(03)00072-1 20
hitting the highlights of the problems in diagnosis and therapy of portal hypertension, as well as the several etiologies that led to that diagnosis. Then a responder covered the things that the presentor had not hit for about 2 more minutes. From then on, for half of the morning or afternoon there was a free-for-all discussion as we told our personal stories of triumphs and defeats in the management of this most difficult pediatric affliction. With a name like Koop, I found names of other attendees to be much more substantial. Clatworthy (William C. from Columbus, Ohio) I had known from training days at Boston Children’s Hospital. C.C. Winkel Smith from Denmark, T. Twistington Higgins from London, Albert Oberniedermayer of Munich, Germany were names to be reckoned with. Winkel Smith was a kindly, affable surgeon who seemed to have considerable experience in most everything in the surgical problems of children. He was beloved by all, and it was difficult eventually to face the fact that several years after that meeting his car was found on the shores of a lake with the driver’s door open; he was never seen again, only to be declared “death by suicide” some years later after an anxious family gave up ever seeing him again. Albert Oberniedermier from Munich, Germany was not only a name to be reckoned with, but also Germanic in behavior of a previous day. Two young surgeons always accompanied him as dieners. He had the attractive habit—at least in the beginning— of smartly clicking his heals at the end of every introduction or when he left your company to move elsewhere. Denis Browne (DB) who had been the chief of surgery at the Hospital for Sick Children, Great Ormond Street was considered to be the father of pediatric surgery in the United Kingdom. He was our only member knighted by the Queen (although we all thought David Waterston should have been after taking out a juvenile royal appendix.) We expected from him, not only the wisdom and skill that went with his professional position, but also the behavior one would expect from the peerage. His capable and lovely wife accompanied him to all BAPS meetings and was eventually made a member. The aforementioned surgeon (DB) of the skin and all of its contents did a lot of procedures that were orthopedic in nature, which most American pediatric surgeons did not. Pediatric orthopedics, if it could be called that, was established before general pediatric surgery was in the United States and remained a special area of surgical interest that most later pediatric surgeons did not pracJournal of Pediatric Surgery, Vol 38, No 7, Suppl 1 (July), 2003: pp 20-26
A GLIMPSE AT THE EARLY BAPS
tice. One of the things DB was famous for was the Denis Browne splint used for congenital dislocation of the hip. It was an astonishing sight in the vicinity of Great Ormond Street, to see children coming by way of public transportation wearing Denis Browne splints, which kept them in a squatting position as they managed their locomotion looking very much like waddling ducks. As meetings grew larger, Sir Denis Browne was always prepared to be a discussant of almost everyone else’s presentation at a formal meeting. He seemed insensitive to the feelings of younger surgeons and their nervousness at presenting a paper in his presence, and he was not particularly kind to them if (when!) he disagreed with them. One of his techniques was to sit as a member of the audience, frequently with Lady Moyra at his side, open a collapsible lapboard and put it across his legs. He then laid out a large collection of slides on the subject about to be presented. As the presenter covered specific things Sir Dennis thought were important to the total presentation, he would pick the appropriate slide from his lapboard and put it back in the box. Eventually, as the presenter wound down his 10-minute presentation, there would only be 3 or 4 slides left out of perhaps 20. Sir Dennis would then take these to the projectionist and fill in all the blanks that he felt had been left out, even though he frequently strayed beyond the narrow confines of the title of the paper. Lady Moyra was a striking, handsome woman. Befitting her title, she always seemed a little austere to me, although we did formally bow in recognition of each other when we met. In the first year that the BAPS met at Manchester, on the last evening before the preprandial sherry, I was in black tie, standing in the front row of passengers in a crowded elevator, with a number of distinguished international pediatric surgeons behind me descending to the lobby floor. We stopped at an intervening level, the doors opened laterally, and Lady Moyra, dressed in suitable finery for the formal dinner, stepped onto the elevator into the small space that was left between the closing doors and me. She turned around, as is the custom to face the front, and as she did so, I was probably the only person in the elevator who could see that in zipping up her evening gown she had actually torn the zipper from the cloth on one side as she zipped from bottom to top. I didn’t have much time to decide how this should be handled, and being a little nervous how Lady Moyra might react to my first impulse, I nevertheless placed one hand on her shoulder and said, “Lady Moyra, I’m going to stand very close to you and let’s walk together across the room to the nearest wall; then you turn your back to the wall, and I will tell you why I am doing this.” Fortunately, without argument she complied, and we made our way to the nearest corner and I explained what I had seen. She then reached around
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to her back and gave a huge audible gasp when her hand encountered bare back instead of brocade. I suggested that she stay as she was and I would go find the necessary things to repair the difficulty and make her presentable for the evening. Fortunately, the concierge was able to find me a little box of miniature safety pins and as though I were inserting subcuticular stitches, I pulled Lady Moyra’s gown and the cloth attached to the zipper into proper juxtaposition so that only the most thorough inspection would have revealed the former problem. Thereafter, Lady Moyra and I were close friends, and we never mentioned the incident again, but my wife and I were the recipients of several invitations to their home and we were visited on one occasion in Philadelphia by her son. It is the opinion of this writer that the BAPS itself, and international pediatric surgery in general, owe a tremendous amount to Peter Rickham. He may not have been the official officer to do the job, but no one tried harder to solidify international pediatric surgery than he did, and no one had a better flair for bringing surgical strangers together, introducing a subject, and making them all sharing surgical colleagues and friends for life. Peter Rickham was also one of the most unconsciously funny men that I have ever known. Not only did he do things that were extraordinarily funny, but he recounted incidents in his life, usually brought about by his own failure to do something on time or not at all, and in poking fun at himself, described so intricately and vividly personal experiences, that one felt he had lived through them with Peter. Peter and I became fast friends from the time he first visited me in Philadelphia, and he came back more than once to stay with us; Betty and I were houseguests of Peter and Elizabeth in Liverpool on several occasions. One time when I was visiting Alder Hey Children’s Hospital in Liverpool without Betty and was staying with Peter, he drove me to work every morning through the Mersey Tunnel. In the United Kingdom, cars then had cranks still attached to the crankshaft protruding from the bottom of the radiator to start the engine by hand if the electric starter failed. This was long after we had abandoned such accoutrements on American cars. One day when Peter was driving me to the hospital for a day in the operating room his car stalled at one of the places in the Mersey Tunnel where the tunnel divides into 2 possible paths. We blocked a long line of traffic behind us, unable to move. Peter, brushing aside all my offers to help, ran out. cranked the car, was unsuccessful, ran back and advanced the spark, repeated the procedure, ran back and advanced the throttle, and repeated the procedure. He must have done this 6 or 8 times before the engine finally sputtered, caught, and we drove away accompanied by honking horns behind us. It is not a scene that ordinarily would have caused me laugh, but the manner in which
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Peter tried to manage the crank, the spark lever, and the throttle, could not be viewed without, not just laughter, but almost hysterics. If you saw it on television, you might say it was over done. Another time when Betty and I were staying with them, Peter told a very plaintive tale about how as a Swiss, he could not stand one more year of heating his home in Liverpool with multiple coal fires in open fireplaces and had installed central heating. He could not believe that his neighbors felt he was not showing the stiff upper lip in cold weather, expected of a true Brit and was almost ostracized. There was another incident that wasn’t funny in itself, but was extraordinarily humorous watching Peter take it all in and finally come to an understanding of what happened. Peter’s wife Elizabeth was a marvelous cook and a great party giver. She had invited a select, but rather large number of the BAPS members to have a buffet supper at their home at the height of the strawberry season. There was a huge punchbowl filled with strawberries much larger than we saw in America at that time. Since then, we seem to have learned the trick of growing them. Next to the strawberries, she had a mountain of whipped or clotted cream. The cream was so high in butterfat that it was actually yellow in color and looked more like mayonnaise than it did like whipped cream. As a result, the guests devoured the strawberries, but never dipped them in the cream as the hostess had intended. After the guests had left, when Peter finally figured it all out, he went into the kitchen and brought another bowl of strawberries and he and I devoured those taking more than ample servings of the yellow cream on each strawberry—not only delicious, but probably contributed to the high blood cholesterol we both eventually had to control. If Peter Rickham served the purpose I have described as the public relations representative for the BAPS, it was Bob Zachary of Sheffield who never let us down with his ability, each year, to outdo his performance at the previous meeting. During some creative time when he was younger and an invalid, Bob had learned some Slavic languages. I believe his mother was Czechoslovakian. He apparently had a flair for learning languages, and I remember at the meeting in 1956 he gave a toast and addressed each foreign member present in that person’s native tongue. And so it went year after year, until he was the host of the meeting in Sheffield in the year that John Holter received an honorary degree from the University of Sheffield for his development of the Holter valve for use in hydrocephalic shunts. On that occasion, the foreign contingent was huge and represented, as I recall, about 50 different countries. Somehow or other, in a very lengthy welcome, Bob managed to say something in each language represented there, although there were
C. EVERETT KOOP
those unkind enough to criticize his pronunciation of some of the more esoteric ones. But a good show it was. Bob was always the first on the dance floor at the final formal dinner dance each year, and an orthopedic problem with his upper spine, which was a spin-off from his encounter with Pott’s disease in his youth, never kept him from doing rather amazing dancing, which included the latest fad no matter how the intricate the gyrations might be. My recollection of the first meeting is still very vivid, and not only did I enjoy immensely the scientific part of the program, but the social portion of the gathering could never be duplicated in the United States. I recall that our final, formal black tie dinner was held at the Apothecary’s Hall. Not only is this an historic building in London with absolutely gorgeous interior decorations, but it is in an out-of-the way spot in that city of streets that don’t run at right angles to each other. It was the only time in my life that I’ve ever given directions to a London cabby when he didn’t know how to get there. Not only that, but he had to inquire of 3 other cab drivers before he found one who guided us through a maze of tiny streets to our intended destination. The sherry party, which proceeded the extremely formal meal, was also formal with 5 wines, but the protocol of announcing the speakers was again something that Americans are not accustomed to and which, unfortunately, as the BAPS meetings got larger and larger, disappeared from their protocol as well. There was a beadle, properly dressed, carrying a mace of prodigious size. He announced the president of the BAPS and dropped the mace to the floor with a resounding thump. Before he announced the second speaker, he mentioned the name of the first; before he announced the third speaker, he announced the names of the first and second; before he announced the name of the fourth speaker, he announced the names of the first, second, and third, and so on. This formality, the uniqueness of the venue and the protocol, all being part of my first trip to the United Kingdom, left such an indelible impression on my mind that I think those hours in the Apothecary’s Hall are still the memory that comes to my mind when I hear someone mention the BAPS. The custom of the BAPS was to alternate venues of the annual meetings between London and some other city in the United Kingdom, and then the BAPS began every few years to choose a foreign venue on the invitation of the host who had become a familiar figure at preceding BAPS meetings. The first was in Stockholm and the second in Rotterdam. David Vervat, the chief of pediatric surgery at the Children’s Hospital of Rotterdam, one of the oldest in Europe, was the host. We all came from so many different far away places that it was not unusual for a number of us to arrive fairly early in the
A GLIMPSE AT THE EARLY BAPS
day preceding the opening of the meeting. The morning of the first day was used for meetings of the council, the executive committee, etc, followed by a luncheon; the scientific meeting began after lunch. On this occasion, there must have been 12 of us who were in Rotterdam on Sunday with no specific plans until Monday noon. David took us out on his very seaworthy sloop for a sail, not only in Rotterdam harbor, but into open water as well. He, with his Dutch friends, was dressed appropriately for the captain of a sizeable sailing yacht, but most of us did not come to the BAPS prepared for such enjoyable leisure time activity and were without appropriate clothes. I felt particularly out of place; I had made the Atlantic crossing safely, but my baggage had not accompanied me. I was dressed in my travel clothes, which, in those days, were much more formal than the more grungy apparel people wear for such travel these days. The second memorable event at that meeting was an audience with Queen Juliana of the Netherlands in her gardens in Amsterdam. David Vervat selected a delegation for the royal meeting consisting of a single representative of a number of countries and the officers of the BAPS, all United Kingdom. I don’t think any of us had been this intimately involved in something as unusual as tea with the Queen, except for Sir Denis Browne, who had already been knighted in the United Kingdom. We naturally looked to him to carry the ball in conversation, but he, for some reason seemed disinclined. Before meeting the Queen, we had all been taken into a side room of the palace and given instructions about when to stand, when to sit, and how long to stay. We even had the crease in our trousers examined. Isabelle Forshall was the only woman in our delegation, and a worthy representative she was; indeed, she was the grand dame of the BAPS membership. Inasmuch as, Sir Denis didn’t take up the initiation of conversation for us and the pause became awkward. I finally came up with something and asked: “Your Majesty, do you remember going into the village of Rijns Atervoude several years ago, walking across the dike and greeting one of your subjects on the morning of her 100th birthday? She was an old friend of mine.” That broke the ice, the Queen said she tried to do that when anyone among her subjects reached the century mark and the conversation flowed freely from then on. We made no faux pas that I know of, left at the right time, but never figured out what it was she carried in that large handbag that she kept close to her feet. The third thing that was interesting about the trip to Rotterdam was that David Vervat had arranged for those who wished to go by train to Leiden to look at the Siemens factory where they made x-ray machines that were widely used in Europe at that time and are now used in America as well. There a pleasant time of fellowship
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on the train and a lot of the conversation had to do with whether there should be, in addition to the BAPS, which served as the international gathering for pediatric surgeons, an additional international society with its own title and its own international agenda. Somewhat reminiscent of things we’d heard about such as treaties being signed in railroad cars in World War I, a group of us made our way through the train into the baggage car, pulled over various objects we found there, used them for chairs and a large box for a table. It was there that the International Society of Pediatric Surgery was born. One of the things I did for many years at the BAPS meetings was to take candid Minox photographs of 2or 3 members together and send a picture of each person photographed in a little folder as a Christmas card saying, “You have been Minoxed.” All of those pictures that I could find in the past several years I’ve passed on to the BAPS to become part of their archives. Of all the presidents of the United States that were in office during my years of association with the BAPS none captured the fancy of Europeans as did John Kennedy. I remember the pleasure of many in the year that the Kennedy half-dollar was first minted, when I brought as many as I could conveniently carry in several pockets and passed them around to friends usually after I’d snapped their Minox picture. There were 2 guests that came to the BAPS meeting very frequently, that we not only looked forward to meeting again, but for whom we had concern, because of the prevailing political climate of the countries from whence they came. One of these was Vaclav Kafka from Prague and the other was Stayslav Doletzky from Moscow. Kafka was beloved by all, because of his political courage as well as his broad experience in pediatric surgery and his ability to explain it in excellent English. But we all knew that while he was at our meeting, his family was under house arrest until he returned, so fearful was the government that his outspoken opposition to the communist regime might sometime cause him not to return to Czechoslovakia. We all felt the same tensions he did, particularly if the day of his departure was a stormy one and he might face the difficulty of arriving late because of weather interfering with the airline schedules. To my knowledge, he always made it in time, but it was his courage in coming to be with us at great personal sacrifice and share our concerns about children’s surgery that endeared him to us all. Doletsky didn’t have the problem of having his family under house arrest, but he had a more difficult problem of being accompanied by one or 2 members of some police agency of the Soviet Union who kept their eyes on him at all times. He and I had our private conversations in the men’s room. I remember one occasion when I, acting as editor of the Journal of Pediatric Surgery, had told
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Doletsky I would return some pictures I was not going to use in an article of his that we would publish, and would do so when I saw him at the BAPS meeting. I carried them with me in a large manila envelope and handed him the envelope in front of 20 or 30 people. Because he was under the scrutiny of his keepers, it was sad to see Doletsky open the envelope, take out the 3 pictures, turn each one so they could see both sides of the photograph, then turn the envelope upside down to show them it was empty, and redeposit the pictures before clipping the envelope together. Someplace along the line, Doletsky, who played the piano very well, had learned American jazz. Many a time, either at someone’s home the night before the meeting began, or perhaps late after a formal dinner was over, a number of us would gather around the piano and sing songs I would never have thought Doletsky, living the monitored life he did in the Soviet Union, would have known. The only thing I ever saw him doing out of keeping with the personality I had come to know happened one night at the Liverpool meeting when we were all on the Mersey River in an excursion boat eating fish and chips; Doletsky came to Steve Gans and said, “Steve, let us exchange pens, so that we can have them as a memory of each other.” Steve, of course, was delighted and took a very expensive mechanical ballpoint pen out of his pocket; I think it was a Cross Pen— gold plated or better— which Doletsky pocketed. He then reached into his breast pocket and gave Steve his BIC. Years after, while I was Surgeon General of the United States, I was sent by the United States to Moscow after Gorbachev’s first visit to President Reagan in Washington, to rework the Health Agreement between the Soviet Union and the United States, which had over the years fallen into disuse. That part of my trip went well, and its sequelae are really part of another story. However, while in Moscow, I tried to reach Doletzky, which immediately attracted the attention of my hosts. I was informed formally, not by health officials, but people I assumed to be part of the Secret Police, that Doletzky was seriously ill in a hospital and could not be visited. Subsequently, I wrote Doletzky in as guarded terms as I could so that he would understand that I had been in Moscow and had tried to reach him. He responded through a German intermediary, whom we had used for communication previously, and told me that he had been in Moscow, physically fit all the time I was there, and would have been delighted to see me. Another interesting incident took place while I was Surgeon General and representing the United States at an International Congress on Aging in Vienna at the same time the BAPS was having its annual meeting as guests of the Viennese Pediatric Surgeons. My wife, Betty, had
C. EVERETT KOOP
accompanied me on this occasion. Unfortunately, her luggage had never arrived, nor did it until a month after our return home. But, there were sufficient number of BAPS wives from the United States attending the meeting who gladly shared their clothing with Betty so that no one would have known she was in this awful predicament of being without her luggage. These acts of kindness by Betty’s friends were much appreciated. We had tried to buy her some clothing in Vienna, but everything Betty tried on fell off of her. She was several sizes smaller than the typical Austrian at that time. To my great surprise, I was elected to the Council of the BAPS, which I considered to be one of the greater honors that have come my way. I served in that capacity as the first American member, and I think my initial term was extended several times to at least 8 years. As an anglophile with at least 2 lines of British ancestry in my forebears, being a Council Member was a role I thoroughly enjoyed. I made fast friends, most of whom visited us in our home in Penn Valley in the Philadelphia suburbs over those and ensuing years. I gave a dinner for my closer friends among the UK BAPS members at the Athenian Club in London shortly before I became Surgeon General. Then in 1981, in the spring of the year I was due to retire, my colleagues in Philadelphia said a formal farewell to me by having a 2-day surgical meeting followed by a final banquet. I was deeply touched that representatives from about 30 countries, all members of the BAPS, came to that affair. In a sense it was the end of my formal relationship with the BAPS, because although I had attended almost every meeting from 1956 until 1980, the rigors of my role as Surgeon General of the United States kept me from active participation around the meetings of the BAPS, which I sorely missed. On one occasion when I gave a lecture on the history of Pediatric Surgery to the American Pediatric Surgical Association in New Orleans, I called attention to the fact that several countries had difficulty in convincing their own surgical community that pediatric surgery was worth special recognition, if not board status. I pointed out that each country eventually relied on someone from another country to make the point with the surgical powers that be. It was rather in line with the biblical admonition that, “A prophet is not without honor save in his own country.” Just as Harvey Beardmore, a Canadian, was so effective in getting recognition for pediatric surgery in the United States, I played a similar role in the United Kingdom, making impassioned presentations before representatives of the Royal College of Surgeons of London as well as the Royal College of Surgeons of Edinburgh. Probably because of that, my British friends nominated me for a Doctor of Medicine, Honoris Causa from the University of Liverpool in 1968. The honorary de-
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gree was bestowed, and a grand affair it was. The citation, however, was embarrassing because it was so far from the truth. In short, according to the citation that was read on the occasion, Eisenhower could never have invaded Europe without me. It wouldn’t be possible to recall to memory all of the remarkable times I had in association with the BAPS, but certain things come to mind that are so indelibly impressed in my memory that I feel they should be mentioned. At the Edinburgh meeting some of the BAPS guests were transported to the bed and breakfast lodgings by rowboats because of the flooding. I remember arriving in Sheffield the one night before the BAPS began and being given a key to my dormitory room. It was pitch black, and no switch that I turned on produced electric light. It finally dawned on me that in those days such rooms are equipped with meters requiring a shilling deposit to get electricity for the next period of time. The question was how to find a shilling, which I obtained from a passerby on the University grounds, and after that to find the meter. This took a good 15 minutes on my hands and knees in the dark until I finally found it in the corner of a clothes closet; a flood of light from all the switches I had left on rewarded the sound of the dropping coin. Once when the BAPS met in Liverpool, I was asked to appear on television in a panel discussion, which went on for about an hour. It was a hot humid day, the room was not air conditioned, and the heat from the klieg lights used in those days was intense. I sat for the interview in a 3-piece suit and, at the close, was drenched with perspiration. My tuxedo for the banquet that night was in a suitcase in Peter Rickham’s office, but I was loath to change my clothes without taking a shower, which was not available. Peter Rickham, innovative as usual, took me down to a room outside the Burn Unit of the Alder Hey Children’s Hospital and ran me a tub that was used for bathing burned children. He said I looked so refreshed after this bath that Andrew Laird, my first Scottish friend in the BAPS followed suit. Then there was the meeting in Marseilles with Michel Carcassonne as the host of an extraordinary lavish social event, which went well on into the late hours of the evening. This was followed by some high jinks by some of the younger attendees who found their antics not to the liking of the Marseilles police and ended up in jail. Michel Carcassonne personally bailed them out in the hours just before dawn. Another feature of that meeting was the (?) misprint by the then secretary indicating that Michel had organised the meeting “on the whores of the Mediterranean.” The meeting in Warsaw was the first time the BAPS ventured behind the Iron Curtain for a meeting. It was a double affair, which had started in Sheffield, and then we
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all flew en masse to Warsaw. At our very first luncheon, in a long refectory, almost immediately after landing, Michel Carcassonne was seated next to a beautiful Polish lady dressed in a skin-tight white wool sheath. As the waiter leaned over her shoulder to serve her a bowl of borscht, his tray tipped and the white dress turned red. She jumped from the table, flounced out of the room, and disappeared. Michel Carcassonne, ever the gentleman, followed to see if he could be of help and finally found her standing in the kitchen stark naked washing her white dress in a sink. That was the only time a naked woman was seen at the BAPS, but it reminds me of a luncheon at a Riviera resort at the Marseilles meeting, where we found ourselves at a topless beach, which included a topless cafeteria, where we ate to the surprise and delight of the adolescent boys accompanying their parents to the BAPS meeting. Even leaving out my American confreres, (except Steve Gans who did so much to put the Journal of Pediatric Surgery on the map) I wish there were time and space to add further references to Max Grob, David Waterston, Matti Sulamaa, Theodore Ehrenpreis, Innes Williams, Douglas Stephens, Fitz Rehbein, Jan Louw, Andrew Wilkinson, Harold Nixon, R.N. Howard, Morio Kassai, Olaf Knutrud, Barry O’Donnell, John Scott, Jim Lister, Ranmniklal Gandhi, Durham Smith, John Atwell, and Dan Young; to add some of the early Scottish members, Wallace Dennison, John Aitken, Jimmy Mason Brown, Fred Robarts, Ian Kirkland, and Rosamund Mackay; then of course Joseph Cohen, Duncan Forrest, Ed Guiney, Harvey Beardmore, Sid Cywes, Gunnar Grotte, Waldemar Hecker, Irene Irving, Peter Jones, Alexander Livadatis, Wolfgang Maier, Carlo Montagnani, Nate Myers, Sam Nissan, Denys Pellerin, Kerijiro Suruga, Peter Wurnig, and almost countless others. They were all competent surgeons, many of them were pioneers who experienced what the first few of us in any locality did, which is anything from skepticism to hostility from the established surgical culture. Yet, of one thing I am certain, all the members of the BAPS I met and whose friendship I cherished, were people who were in the field of pediatric surgery because they wanted to see children given better care and deeper understanding than was previously available to them in a surgical world dominated by adult patients whose priorities came first. The BAPS had a tremendous beneficial affect on the growth of pediatric surgery in the United States. That influence, with the establishment of the Surgical Section of the Academy of Pediatrics in 1948, the founding of the American Pediatric Surgical Association in 1970, and the ratification of the Journal of Pediatric Surgery as the
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official journal of the BAPS enabled the American specialty of pediatric surgery to reproduce in 35 years what it had taken general surgery to do over approximately 200 years. The BAPS, in 50 years, has come from a small coterie of people with a sincere desire to improve the welfare of children in surgery, who knew each other, worldwide, by their first names, to a preeminent organi-
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zation that has provided a home for international pediatric surgery. In this, the 50th Year of the BAPS, I raise a virtual glass to toast the BAPS, as I have so many times in reality at their annual meetings, to thank them for a job well done, for the inspiration they have provided to so many, and especially for their accomplishments that have benefited countless children and their families.