The WFN comes of age

Abstract

Mr. President, it is for me, as singular honour and privilege to have been invited to give this historical account celebrating the Golden Jubilee of the WFN, which has played such an important part in my life [[1]Walton J.N. The spice of life. Heinemann and Royal Society of Medicine, 1993Google Scholar]. In the mid-1850s, neurologists from across the world concluded that there would be much to be gained by establishing a worldwide federation of national neurological societies to promote the dissemination of information and scientific knowledge in the neurosciences, to foster collaborative international programmes of clinical and basic neurological research and to enable neurologists in developed countries to assist their less fortunate colleagues in the third world to promote high standards of neurological care and research and to develop improved services. Among the prime movers were Pearce Bailey from the USA, Ludo Van Bogaert from Belgium, Georg Schaltenbrand from West Germany, Houston Merritt from the USA, Macdonald Critchley from the UK and Raymond Garcin of France. The proposal was endorsed by the American Academy of Neurology, and an application, drafted by Pearce Bailey and Ludo Van Bogaert, to the National Institutes of Health (NIH) resulted in a grant of US $1,206,190 being awarded annually for five years in order to establish an office, to cover secretarial, postal, telephone and all other administrative and travel costs. It was also agreed that a new journal entitled World Neurology, edited by Dr. Charles Poser, should be launched in order to disseminate information about the activities of the Federation worldwide. Ludo Van Bogaert, a distinguished neurologist and neuropathologist about whom we have just heard from Jacques de Reuck, was elected as the Founding President, and Pearce Bailey as Secretary-Treasurer General, and an office was established in Antwerp. The World Federation of Neurology (WFN) was effectively launched in 1957 at the International Congress of Neurological Sciences held in Brussels in that year; 22 national neurological societies worldwide became members and each agreed to pay an annual subscription of US $2 for each active member. Van Bogaert's leadership was outstanding, and very few neurological societies failed to join. It was also agreed that, in order for the WFN to gain international credibility, it should promote international collaboration in research, and accordingly many Problem Commissions, each with international memberships, were established to deal with topics of fundamental importance to clinical neuroscience. The success of these commissions was highlighted by the fact that the NIH gave a further grant of US $215,000 to fund a research project on the geographical pathology of cerebral vascular disease, and additional grants of between US $25,000–$40,000 were given to support the International Congress of Neurology in Rome in 1961, the first Asian and Oceanian Congress in Tokyo in 1962 and the first Pan-American Congress in Lima in 1963. Among the Commissions established at the outset were those on cerebrovascular disease, comparative neuropathology, cerebrospinal fluid, child neurology, geographical neurology, tropical neurology, neurochemistry, neuro-opthalmology and neurogenetics to name but a few. Professor Franceschetti, the noted Geneva ophthalmologist, chaired the Commission on Neuro-opthalmology, and his close friend and associate, David Klein of Geneva, Founding Chairman of the Commission on Neurogenetics, collaborated closely with him. Unfortunately, after two years, World Neurology, as the WFN's journal, foundered when the publishers decided it was not viable financially, but the Journal of the Neurological Sciences was soon established as its successor and was first published by Elsevier under the editorship of Macdonald Critchley in 1964. At the 1961 International Congress in Rome, it was clear that the WFN was by then firmly established and Ludo Van Bogaert was elected unanimously to serve for a second term of four years as President. Before the WFN had been formed, the quadrennial International Congresses of Neurology were organised by the Neurological Societies or Associations of the host country, and the next Congress host was chosen at the end of each Congress. Soon, however, the growing strength of the WFN made it clear that this world organisation should play a significant role in organising future congresses, and the 1977 Congress in Amsterdam was the last one at which a partnership between the Dutch Society of Neurology on the one hand and the WFN on the other had organised the Congress, and chose the programme, the main themes and the speakers. From 1981 onwards it was agreed that the WFN would choose the venue for subsequent World Congresses and would also decide upon the main themes, symposia, rapporteurs and other details, but in close collaboration with the officers of the neurological society of the host country. A pattern then emerged whereby the Council of Delegates of the WFN, having chosen the site for the next such meeting, would meet with the local organising committee two years before the congress in order to finalise the arrangements, and that mechanism still prevails. My personal involvement with the WFN began in 1964 while Ludo Van Bogaert was still President, when he travelled from Antwerp across the Channel and by train to Newcastle upon Tyne to meet me, in order to ask whether I would be interested in establishing a Problem Commission on Neuromuscular Disease. We had a long and fruitful discussion in the coffee shop at Newcastle Central Station before he took another train to return immediately, without ever leaving the station premises. I agreed immediately, and was therefore able to attend a meeting of secretaries of the problem commissions in Antwerp in December 1964. That meeting had been called because the financial resources of the WFN were running low and because NIH had refused to renew the supporting grant, which had been awarded in anticipation that the WFN, once established, would generate its own income. As the income of the WFN itself was insufficient to sustain the expenses of its central office while giving grants to problem commissions to promote their activities, Van Bogaert proposed that a quasi-independent organisation called the World Association of Neurological Commissions should be established under the loose control of the WFN, but should be responsible for raising their own funds in support of their activities. I confess that as a new boy I did have some reservations about this proposal, as it seemed to me that the WFN was dependent for its future viability and international reputation upon the existence of its research activities. Nevertheless, the Officers of the WFN accepted Van Bogaert's proposal and my Problem Commission on Neuromuscular Disease was established, finally, in Newcastle upon Tyne in January 1965, when I was elected Chairman and Secretary of that body. At the 1965 Congress in Vienna, Macdonald Critchley was elected President of the WFN and Henry Miller of Newcastle became the Secretary-Treasurer General; the handover was initially smooth. Soon after his election, however, Critchley became increasingly concerned about the proposal to remove the problem commissions from the WFN and consulted the national delegates of all the affiliated societies. Since by then I had agreed to succeed him as Editor-in-Chief of the Journal of the Neurological Sciences, I became for the first time an Officer of the WFN, and because of growing conflict between Van Bogaert on the one hand and Critchley on the other, a meeting was arranged of past and present officers of the WFN, with chairmen and secretaries of the problem commissions, in Geneva in July 1966. Despite the glorious surroundings and the excellent hospitality provided for the attendees, confrontation quickly emerged, and Critchley read out a list of the national delegates who had written to him opposing the formation of the World Association of Neurological Commissions. At this moment, it seemed almost as though Critchley and Van Bogaert were in danger of coming to blows, and I am told that what many later considered to be my skill in achieving compromise may have emerged for the first time on an international scene. I proposed, after a very heated debate, that the WFN should create a Research Committee, subject to the supervision and control of the Federation but with its own Chairman and Secretary-Treasurer, who should then be accepted as officers of the WFN but would be subject to the authority of the President and the other chief officers of the WFN. I spent some time after dinner that evening in setting out my proposals on paper before presenting them to the adjourned meeting the next morning. After much vigorous argument, contention dissolved, sweetness and light prevailed, my proposals were accepted, and even Van Bogaert on the one hand and Critchley on the other felt able to shake hands on ‘a deal’. Thus the Research Committee of the WFN was born. It subsequently devised its own statutes, and the first Chairman was Professor Franceschetti, with David Klein as Secretary-Treasurer General. The problem commissions were now renamed as research groups, under the auspices of the Research Committee, and each research group was represented by its chairman and/or secretary on the parent committee. In the meantime the WFN itself struggled along on the financial resources derived solely from subscriptions from the national neurological societies and their associations. However, Critchley, one of the most intelligent and articulate neurologists of his generation, was an outstanding leader, and Henry Miller, of charismatic and ebullient personality, invariably succeeded, when supporting Mac (as we called Critchley), in enlivening any meeting and debate in which they were both involved. Hence, in 1969, when the next World Congress of Neurology was held in the Hilton Hotel in New York, under the vigorous and efficient, if slightly eccentric, leadership of Houston Merritt, they were both re-elected to serve for a further four years. The WFN then ticked over smoothly without any major crises, but without any major initiatives either, until 1973 when we met in Barcelona. Before that meeting the usual consultations had taken place about whom the WFN would wish to nominate as its next President. There was unanimity in Europe and in the USA, and in other countries throughout the world, in choosing the kindly, judicious and statesmanlike Sigvald Refsum of Oslo (formerly of Bergen). His name will always be remembered for his description of the rare disorder which he called heredopathia atactica polyneuritiformis, but which later became generally known simply as Refsum's Disease. Refsum chose as his Secretary-Treasurer General Professor Bent d'Fine Olivarius of Denmark. For a time this arrangement worked well, but Professor Olivarius became ill and major problems arose when it turned out that annual requests to member societies and associations for the payment of subscriptions had not been despatched, and that important correspondence directed to the Secretary-Treasurer General had not elicited any replies. For a year, through no fault of the President, the affairs of the WFN were chaotic, but eventually Professor Olivarius resigned, and was replaced by the efficient, capable and stately figure of Professor Palle Juul-Jensen of Aarhus in Denmark. He was a distinguished clinical neurophysiologist, and former Dean of his medical school, and he soon brought the affairs of the WFN back under control, with improved financial management and administrative stability. By now it was clear that Professor Franceschetti was finding it increasingly difficult to fulfil his responsibilities as Chairman of the Research Committee, and David Klein, who had resigned from his Chair of Clinical Genetics in Geneva, was also finding it difficult to continue with his responsibilities. Hence, at a meeting of the Research Committee in 1977, after informal consultations during the Amsterdam Congress, I was elected Chairman of the Research Committee with Armand Lowenthal of Antwerp as Secretary, while David Klein continued as Treasurer until 1985. In Amsterdam, nevertheless, it had become increasingly clear that the WFN was struggling financially, and no new prospects of increasing its income had been identified. Professor George Bruyn, Secretary of the Amsterdam Congress, proposed that the WFN should establish a Finance Committee in an effort to improve matters; this was approved and George was elected chairman. Subsequently, he and the Finance Committee endeavoured to find ways in which the research groups, some of which were healthy financially and some of which were not, could perhaps contribute to the funds of the WFN. A number of proposals were made, but none was effectively carried through, so that a few years later it became increasingly clear that the research groups would effectively go their own way in fundraising, and that the WFN could not depend upon any income from them, particularly since some of the research groups had matured to such a degree that they had been transformed into international societies. This was certainly true, for example, of the International Society for Neuropathology, the American and European Societies of Neurochemistry, the International Child Neurology Association and many more. When it became clear that such international societies had overtaken the functions of many research groups, some of the latter were disbanded and the International Societies were invited to become Corporate Members of the Research Committee, with the payment of an annual subscription and with representation by one or two members on the Research Committee. That arrangement was of particular importance when, at a later stage, it was agreed that in planning a programme for world congresses, the Research Committee and its individual groups should have the right to nominate themes and symposia. Indeed, a consensus gradually emerged to the effect that one main theme for each world congress would be chosen by the host neurological society or association, and the remaining three main themes, as well as the subjects of symposia, would be chosen by the Council of Delegates of the WFN in collaboration with the members of the Research Committee, based, in many respects, upon proposals coming from the research groups. As Sigvald Refsum's eight-year term of office as President drew towards a close, the Council of Delegates had appointed a Nominating Committee to recommend to the Council one or more candidates for the Presidency of the organisation, and in Kyoto in 1981, Professor Richard (Dick) Masland, former Director of the Institute of Neurology in the New York Presbyterian Medical Center, was nominated and was elected unanimously. There was general agreement that it was time for the WFN to have an American President. At first, Dick Masland suggested as his Secretary-Treasurer General Professor Pierre Dreyfus, Professor of Neurology at the University of California in Sacramento, but for a variety of personal and administrative reasons Pierre was compelled to withdraw, and Dick nominated in his place Professor James Toole, Professor of Neurology at the Bowman Gray School of Medicine in Winston-Salem, North Carolina, who had an international reputation for his work on cerebrovasular disease. On his appointment as President, Dick immediately recommended that the Chairman of the Research Committee should also become First Vice President of the WFN, so that his team was then complete, with himself as President, myself as Chairman of the Research Committee and First Vice President, Jim Toole as Secretary-Treasurer General, and Armand Lowenthal as Joint or Adjunct Secretary-Treasurer General and Secretary of the Research Committee. It was also agreed that the Editor-in-Chief of the Journal of the Neurological Sciences should, with those four chief officers, constitute the Management Committee of the WFN. Within a few weeks the outstanding secretarial support and financial management of Jim Toole helped the WFN to go from strength to strength, in that a computerised database of the members of the member societies was established, the Research Committee accounts, with its increasing income derived from corporate members, was put on a sounder footing, and budgets to cover office and secretarial expenses for the principal officers were agreed. In addition, for the first time, it became possible through corporate sponsorship to prepare a quarterly newsletter entitled World Neurology, which was to be sent to all of those on the central database. When the World Congress of Neurology was held in Hamburg in 1985 under the inspired Presidency of Klaus Poeck of Aachen, its organisation was superb, and it became abundantly clear that the organisation of WFN meetings, of its constituent committees and of the Research Committee, had become professionally planned, and that the WFN had become an established organisation with a significant role in world neuroscience. This view was heightened when in 1987 a formal association was agreed with the Mental Health Division of the World Health Organisation (WHO), directed by Dr. Norman Sartorius. The WFN was therefore consulted officially for the first time about revisions of the international classifications of disease, and the international nomenclature of disease; despite our objection to the inclusion of cerebrovascular disease in the cardiovascular rather than in the neurological chapter, this collaboration was in all other respects fruitful, and I, with Armand Lowenthal, represented the WFN at meetings with other NGOs in the neurosciences at WHO meetings in Geneva at least once a year. By this time, too, other committees were established within the WFN, including a Publications Committee, a Constitution and Byelaws Committee and an Education Committee, in which for the first time proposals relating to neurological education were mooted through the spirited advocacy of Dr. Matthew Mencken, who, with Ted Munsat of Boston, USA, had founded a research group on Neurological Education from which that Committee was effectively derived. Some difficulties arose over rules relating to membership of the WFN, as it had been agreed by the Council of Delegates that any country with a neurological association with more than five members could nominate a single delegate; for a time this caused some concern in the USA, with many thousand neurologists represented by a single delegate, but eventually the American Neurological Association and the American Academy of Neurology agreed harmoniously to nominate the American representative in rotation. The problem of China was exceptionally difficult, however, since very early in the days of the WFN, Taiwan, calling itself the Republic of China, was accepted and regularly sent a delegate to meetings. The People's Republic of China for many years refused any international contacts, but when the Cultural Revolution ended and its government became more open, Chinese neurologists began to look towards the forging of international links, and examined the question as to whether the Chinese Society of Neurology might become a member of the WFN. They refused, however, to do so for as long as Taiwan remained a member, and all attempts at compromise that we offered were rejected by both organisations, despite a fruitful meeting that I had with the officers of the Chinese Society in Beijing. This matter had remained unresolved until, through the diplomatic skill of the current President, Johan Aarli, China has now become a member alongside Taiwan and Hong Kong. Throughout this period, however, despite the increasing success and influence of the WFN, finance continued to be a problem. Despite its difficulties, the Federation had always offered a loan equivalent to US $30,000 to the local organising committee of any world congress to enable them to begin planning and to cover initial expenses. The loan was given interest-free, with the agreement that it must be repaid after the congress in question, along with an agreed percentage of any profits which the congress may have achieved. The Hamburg conference had generated a modest profit which revitalised the Federation funds. The next Congress in New Delhi in 1989, organised with great efficiency by Professor Jagjit Chopra, was an enormous success culturally, scientifically and financially, but unfortunately Indian government regulations did not allow any profits to be sent out of the country. Therefore, although the WFN loan was repaid, the congress profits could not be deployed except within India itself, where the funds were subsequently used for the support of neurological activities of many kinds. At the congress itself, however, the Finance Committee recommended, and the Council of Delegates accepted, that the annual payment from each neurological society should in future be US $5 per head of all subscribing members. This figure was subsequently revised to £3 sterling when a permanent office for the Federation was established in London, and that arrangement has continued to this date. Happily, too, every World Congress of Neurology since that time has been a great success financially, to the extent that, with an agreement that the profits should be divided equally between the host society and the WFN, the organisation has become financially stable, and able to embark upon many initiatives which had previously been impossible. As the Delhi Congress of 1989 was approaching, the usual lobbying began about whom the WFN would nominate as successors to Dick Masland and Jim Toole. I was aware that the Nominating Committee would be likely to put forward my name as a candidate for the Presidency, and that I would be able, in accordance with the WFN Constitution and Byelaws, to nominate my own Secretary-Treasurer General. I knew from conversations and private correspondence that the issue was likely to be contentious, and that the report of the Nominating Committee would be opposed for the first time in the history of the WFN. I had learned that George Bruyn, Secretary of the Amsterdam Congress and subsequently Editor-in-Chief of the Journal of the Neurological Sciences, was making a serious bid for the office and had written to many delegates suggesting that the next President should not come from a country from which a previous President had been chosen. Knowing that Macdonald Critchley was a former President made the significance of that proposal very clear. When the time came for the Council of Delegates to consider the report of the Nominating Committee, therefore, I absented myself from the meeting, and I am told that after a somewhat difficult discussion, several delegates recommended that the report of the Nominating Committee should not be accepted and that alternative names might be proposed for the Presidency and for the other offices of the organisation. The Council was therefore compelled to recommend a new procedure, whereby formal nomination and seconding of candidates for each office would be allowed, prior to a second meeting of the Council later in the week, when these nominations would be considered along with those proposed by the Nominating Committee. At the second meeting there was a secret ballot and I was greatly honoured to be elected President by 32 votes cast in my favour with 17 for George Bruyn as the alternative candidate. My nomination of Frank Clifford-Rose as Secretary-Treasurer General and of Klaus Poeck as Vice President and Chairman of the Research Committee was then accepted without dispute. I was very glad to have the support, not just of Klaus Poeck, but also of Frank Clifford-Rose, who proved to be an exceptionally assiduous, efficient and hardworking Secretary-Treasurer General who established the WFN office in London and updated the membership database. Jim Toole succeeded George Bruyn as the Editor-in-Chief of the Journal of the Neurological Sciences and therefore continued to be a member of the Management Committee in that new capacity. It would I believe be invidious for me to spend time describing the eight years I spent as President of this organisation, but I can only say that these were among the most interesting, fruitful and enjoyable years of my life, when my dear late wife Betty was able to travel with me to many countries across the world to represent the WFN, and to meet and consult with innumerable neurologists. One WFN delegate even referred to my wife, who was a superb hostess on many formal occasions, as ‘world neurology's sweetheart’, something which both she and I greatly appreciated. The committee structure which we had established worked, I believe, efficiently, and research and educational initiatives continued to develop. Many countries from Eastern Europe, formerly a part of the Soviet Union, joined the WFN on becoming independent. With the aid of my indefatigable secretary, Rosemary Allan, I established a Presidential Office in Sir William Osler's old house at 13 Norham Gardens in Oxford, as I had retired from the Wardenship of Green College, Oxford, when my Presidency began. During my Presidency I was glad to have played a part in establishing the European Federation of Neurological Societies, but was disappointed that attempts to merge that organisation with the independent European Neurological Society foundered, and both organisations continue to function independently. Yet another wonderful world congress was held in Vancouver in 1993, at which I was elected to serve for a second four year term as President. There is no doubt that the WFN really came of age during the Presidency of Dick Masland, and I hope and believe that I was able to continue to carry the torch forward and to develop the organisation increasingly in my years of office, before my Presidency terminated in 1997, at yet another outstanding congress in Buenos Aires. For some time before then, the Council of Delegates had been considering whether or not it would be appropriate, in view of the growth and the increasing influence of the organisation, to abolish the principle whereby the Presidents could be reappointed for a second four-year term; that recommendation was accepted towards the end of my Presidency, so that my successor, Jim Toole, served for four years and not for the eight-year term which I and my predecessors had enjoyed. He led the organisation, however, with outstanding capability, and introduced many new research and educational initiatives with the able support of his colleagues on the Management Committee and the assiduous secretarial work of Richard Godwin-Austen of the UK, who was based, with the aid for the first time of a full-time executive officer, Keith Newton, at the London office which Clifford-Rose had initially set up. Happily, Betty and I were able as guests to attend the London Congress in 2001, where I know that my colleagues from the Association of British Neurologists did the WFN proud with a superbly organised event. The WFN since that time, under the Presidency at first of the notable Japanese Neurologist Jun Kimura until the Australian Congress of 2005, and now the distinguished Norwegian Neurologist Johan Aarli, former First Vice President, the organisation continues to flourish as never before. Truly, the WFN has not only come of age but is a mature, vibrant and deeply respected influential international body. It has been a privilege to share this historical commentary and the exciting experiences of my WFN involvement with you all.