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Reflections on the 100th anniversary of the International Pediatric Association (IPA)

At the beginning of June, I was happy to receive a surprise e-mail from the office of the International Pediatric Association (IPA), which will celebrate the 100th anniversary of its founding this year and hold its 26th International Congress of Pediatrics (ICP) from August 4 to 9 in Johannesburg, South Africa. As former chair of this organization, I was asked to send a curriculum vitae, photograph, and video message as a way of contributing to the commemorative events. In this month's message, I would like to introduce my experience with the IPA and its activities (ICP) as an international pediatric organization that is dedicated to improving the mental and physical health of children around the world.

It is not hard to understand that the history of pediatrics is closely related to the birth of the children's hospital, at least, in the developed countries of Europe and North America. France was the first to establish a children's hospital with Hopital des Enfants Malades in Paris in January 1801. I visited this hospital a number of times from the late 1970s to the late 1980s. It is now merged with Hopital Necker, an old hospital founded in 1778 where the physician Rene Laennec invented the stethoscope in 1816. While children's hospitals used to be separate institutions, today they are part of general hospitals.

The founding of this children's hospital in Paris was the beginning of a movement to establish children's hospitals in more developed countries around the world. The children's hospital in London where I interned in 1960s was founded in 1852 by a physician who had studied in France. Hospitals were subsequently established in the various regions of Europe and in the United States. In fact, the Children's Hospital of Philadelphia, the first pediatric hospital in the United States, was founded in 1855 and the Children's Hospital Boston in1869. Both were based on an old model in which many children's hospitals began as orphanages. It is worth noting, however, that general council for hospitals that founded children's hospitals in Paris was a public body.

The preeminent children's hospitals that we see in the United States were established in the 20th century, in particular after World War II, as part of a university medical school so that the results of modern pediatric research could be directly applied in pediatric care. Children's hospitals in Japan, however, were founded extremely late. The first one was the National Children's Hospitals in 1965, the same year that the international congress was held in Tokyo. As for pediatrics departments of university hospitals, however, the first had been established nearly ninety years earlier, at the University of Tokyo.

Returning to the topic of the IPA, it was just 100 years ago in 1910, the tenth year of Hopital des Enfants Malades in Paris, that representatives from the pediatrics societies in Europe, gathered at the initiative of the French society to discuss establishing an international organization. It was two years later in 1912 that the IPA actually held its international congress. Societies of internal medicine had already held international conferences several years prior to this, which indicates that the internationalization of the medical societies began around this time.

The international congress was to be held every three years, but it did not get off to a good start - no doubt because World War I and World War II intervened and Europe turned into a battlefield. Records show that the fifth congress was held in New York in 1947, two years after WWII. This was 35 years after the first ICP, during which time only three conferences had been held.

As mentioned above, it now seems remarkable that the IPA held its congress two years after WWII. This fifth congress, coming after two successive World Wars, must have been a truly special event for the IPA. New York in the United States, which had not experienced any fighting on its soil, was chosen as the venue. The purpose was to gather together pediatricians from all over the world to discuss the problems faced by children who are the most vulnerable victims of war. I am moved by the high-minded spirit of this endeavor.

Furthermore, the American Pediatrics Society, which hosted the fifth congress, invited Professor Kuriyama of Department of Pediatrics, University of Tokyo and others to participate in a symposium and offered to bear the travel expenses. This in itself indicates the extent to which pediatrics in Japan was highly regarded by its peers at the time. With the support of the GHQ during the occupation of Japan, this visit almost took place, but ended up canceled, apparently due to opposition from some members of the Far Eastern Commission in Washington, which was in charge of Occupation policy-making.

After this, pediatricians from Japan took part in the international congress held every three years, albeit in limited numbers. About twenty pediatricians from Japan participated in the 10th ICP held in 1962 in Lisbon, where the IPA executive committee decided to hold the 11th ICP in Tokyo, the first in Asia. Up to then, the international congress had only been held in Europe and North America, making the Tokyo congress a truly historic event.

While I was studying in London, I attended in the Lisbon congress as an assistant to my mentor, Professor Takatsu, who participated as president of the Japan Pediatric Society. As my first congress, it enabled me to experience what academic conferences were really like. I returned to Tokyo University in 1964, and assisted Professor Takatsu at the 11th international congress in Tokyo in 1965.

One reason that the IPA decided on Tokyo as the venue for the 11th international congress was Japan's rapid postwar recovery from defeated nation to economic power capable of hosting the Olympics. It was also due to the fact that the infant mortality rate, which had equaled that of developing countries after the war, declined dramatically, improving over that of North American and Europe and even beginning to overtake that of Scandinavian countries where rates had been the lowest. The field of pediatrics in Japan was also shifting to a new framework, away from its primary focus on the treatment of infectious disease to one that was concerned with congenital disorders and premature infant and neonatal disorders. Professor Takatsu aptly made "Prenatal Pediatrics" the theme of the 11th congress. The Tokyo congress turned out to be an enormous success and Japanese pediatrics became highly regarded internationally.

Holding the ICP in Tokyo also had a lasting effect on the IPA thereafter. First, more pediatricians from developing countries began to sit on the IPA executive committee, which had previously been composed only of pediatricians from developed countries. The appointment of Professor I. Dogramaci, a Turkish pediatrician, to the post of IPA director was a major step in this direction. If my memory serves me correctly, the 12th international congress after Tokyo was held three years later in Mexico City. But it could be said that these changes began in Tokyo.

This can be somewhat inferred from the following. At the time, the IPA had no post of president; the director represented both the executive committee and the society. At the Tokyo international congress, Professor Janeway of Harvard University in the United States succeeded Professor Fanconi of the University of Zurich, Switzerland as the IPA director. This seems to indicate that, as a result of executive committee meetings in Tokyo, Professor Janeway temporarily accepted the post to create an IPA that would benefit developing countries, and at the IPA board of directors held at the Mexico congress, Professor Dogramaci was chosen director even though he had not attended the congress.

Professor Dogramaci's appointment to IPA director made sense from a number of perspectives. First, he had been the Turkish representative to the first postwar WHO plenary session held in New York in July 1946 and a signatory to WHO charter. In his work with the WHO, he had also become knowledgeable about the problems facing children in developing countries as well as in his native Turkey. After attending Istanbul University in his youth, he studied at some of world's most renowned children'fs hospitals in Paris, Glasgow, and Boston. Furthermore, Professor Janeway had been his teacher at the Boston Children's Hospital. In this sense, Professor Dogramaci had an understanding of pediatric medicine that was international in scope. Always very honest and aboveboard when it came to financial matters, he carried out IPA work at his own expense.

It was Professor Dogramaci who created the post of president at the IPA and urged me to consider the position. The next president was to be chosen at the IPA executive committee held at New Delhi international congress in 1977, and he must have been apprehensive at the fierce campaign waged by a candidate pediatrician. He stopped in Tokyo on the way to a WHO conference in Manila and asked me directly if I would be interested in running for the post. I think he was concerned that the authority that came with either the ICP or IPA might be abused. Of course, we felt a certain sense of camaraderie between Turkey and Japan, and Professor Takatsu who had been instrumental in the success of the Tokyo congress also lent his support.

At the plenary session of the IPA at the 1977 New Delhi international congress, I was elected in the run-off and sat on the IPA executive committee as president-elect. Since then, for twelve years, I had been involved with the executive committee as vice president and president and with the standing committee as past president.

After the Tokyo congress, followed by the one in Mexico City and later in Buenos Aires, it appears that congresses were being increasingly hosted by the less developed countries and that more IPA officers came from the less developed countries as well.

The IPA covers the entire globe, comprising 144 national societies, 10 regional societies, and 13 subspecialty societies. However, the IPA now seems to leave specialized research in pediatrics to societies for specialized fields or pediatric research societies, particularly in the United States, Asia, and Europe. But the child population is far larger in less developed nations where the problems are many and serious, a situation that truly calls for improved pediatric medical care. It seemed to me that the international congresses should now think of how to apply pediatric research findings to improve the actual lives of children.

I learned much from Director and Professor Dogramaci during the 12 years that I was involved with the IPA, from the New Delhi congress in 1977, the third in Asia, to Paris congress in 1989 to commemorate the French Revolution. In particular, I learned much about solving the problems of children in developing countries, the role that pediatricians should play and its limitations. During this time, I traveled to Europe, South America, Asia, and various countries in Africa and have many happy memories of exchanges with the leaders and members of each of the pediatric societies. In particular, I can clearly see in my mind'fs eye the children I saw in the streets and at the airports of Kenya and Cote d'fIvoire.

Unfortunately, Professor Dogramaci passed away in February 2010. I last saw him four or five years ago at a party to celebrate his ninetieth birthday in Ankara. I am indeed very saddened to think that I will not be able to see this great and gentle man at the 100th anniversary celebration of the IPA this year.

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