ESPHI
European Society of Pediatric Hematology and Immunology

HISTORICAL NOTES: 1969 - 1992
by Walter H. Hitzig
Zurich

Introduction
Prior to the ESPHI-meeting scheduled for 1991, but postponed 10 ApriI 1992, the organizing president, prof. Ozsoylu from Ankara, asked me to write a retrospective on the development of our Society. Since I was quite involved in its first years, and since its fate is still close to my heart, I started to review my papers. I found that after 24 years it might be worth-while to remember the initial intentions of the founders and to compare them with the present situation.
I have no ambition to be a historian. Instead, my notes are casual and incomplete. I will be grateful, if readers can correct me or add important facts. lnitially, I bave simply extracted data, names and statements from the minutes and scientific programs of our meetings. In addition, however, I sometimes rely on my recollections, and finally I feel free to express my personal views and thoughts and 10 submit them to criticism.


1.Development of pediatrics
The care and treatment of sick children was, up to the end of the 18th century, almost entirely left to mothers and midwifes. Doctors felt utterly helpless, when faced with the troublesome problems of nutrition, infections and malformations. Growth and development, behaviour and education were barely studied, but considered to belong into the realm of teachers and philosophers. The term ”hospital” designated a house or home, where abandonned children found shelter, food and clothing. That a majority of them died shortly after admission, was accepted as inevitable fate. In the Medieval society and far into the 19th century the ”value” of a child’s life was much lower than to-day.

1.1 Initiation of pediatrics
During the 19th century Internal Medicine slowly rose to a medicaI and gradually to a scientific specialty. It centered around adults, and children were treated with the same methods. For practical reasons, lateron children were separated from the adults and nursed in special wards. Out of such hospitals, the first doctors emerged who devoted most of their time to the care of children.
Few children’s hospitals in the modern sense were founded in the 18th century. Most of them, -usually charitable donations of wealthy individuals -, date from the second half of the 19th century, as became evident in their centennary celebrations during these last years or decades.
The first concerns of the pioneers of pediatrics as a scientific discipline appear relatively simple to us: they studied the normal development and growth of human beings, their nutritional needs and the chemical composition of their body. By introducing exact measurements, they achieved the first step towards scientific evaluation. Approximately between 1880 and 1930 thus the foundations of pediatrics were laid.
The following generation of pediatricians, who could devote all their time to the welfare of children, started to identify diseases unique to this age group, in particular malformations and metabolic errors incompatible with normal life. Since they noted that many of these disorders occurred in families, they became also interested in human genetics.
In all these fields new techniques were wanted. To develop them, the help of engineers was needed who were able to take advantage of all kinds of innovations in chemistry and physics. With the resulting accurate data, knowledge of physiologic and pathologic body conditions grew in logarithmic speed. Favorable economic conditions contributed to the expansion of research activities.
Improved means of communication made it possible to learn with ever decreasing delay what was going on in other parts of the world. But it became more and more difficult to follow all the wealth of on-going research activities and to keep track with alI the new discoveries and pubiications.

1.2. Emergence or pediatric subspecialties
Alert and ambitious pediatricians, eager to make their own contributions, therefore started to restrict their activities to one or two fields, where they could hope to gain outstanding competence: the process of sub-specialization started in the forties, and it continues unhampered into the present time. In Internal Madicine, the same development had started about one generation earlier. It generated new specialists like neurologists, cardiologists, hematologists etc. and of course also pediatricians.
The great university hospitals in the USA took a leading role in this process. Many of their subspecialized divisions and laboratories became world-famous. The generation of European pediatricians born in the twenties became aware of these facts and started a real pilgrimage to the different American ”Meccas ” , eager to leam the new sciences right at the sources. Some of them stayed and thus definiteIy emigrated, but some of those who came back started their own work, stimulated by the new ideas and tightly connected with their mentors. Networks were tied between the old and the new world which today unite different classes of subspecialists.

1.3. Organization or pediatric research in Europe
After World-War-II in Europe everybody wanted to communicate with colleagues in other countries with similar interests and to catch up with the developments in the USA. Guido Fanconi, my famous teacher, felt the obligation of his generation to foster possibilities of mutual exchange. In 1957 he invited his colleagues holding the Chairs of Pediatrics all over Europe, each to delegate two young collaborators to attend a Symposium at the Kinderspital in Zurich. The main topic was devoted to the Metabolism of Water and Electrolytes. This week in Qctober 1957 became very important for most of the participants: they could make new scientific contacts, and also many lifelong friendships were initiated.
In the following year (1958) most of these people gathered again in Bern and decided to meet regularly in the future: the ”European Club for Pediatric Research” was thus founded. It turned out that it would gain considerable influence on the European pediatric scene, since the majority of these young people whithin the next decade or so advanced into leading positions in their respective countries. Unfortunately, however, the ”Club”, which had deliberately restricted the number of its members to a maximum of 50, was in later years envied by younger people who could not be admitted, and it acquired the fame of being ”exclusive”. After many heated and controversial discussions, the ”Club” finally decided to drop the membership restriction and to admit every qualified candidate: in 1969 it changed its name to ”European Society for Pediatric Research = ESPR (table l).



2. Scientific development of hematology
During the last half century stormy scientific developments have taken piace. They had considerable impacts also in our Society, as may be seen from the following -incomplete or maybe even slightly incorrect - list:

2.1. Time table
Up to 1950, hematologists essentially observed and described the morphology of blood cells; their instrument was a microscope. It could be improved, but this didn’t open up new horizons. Anyway, to avoid misunderstandings: I consider morphology still as the foundation of hematology!
Since the fifties new methods for the characterization of very labile proteins became available for clinical laboratories by simplified electrophoresis apparatus and chemical tests. They enabled the differentiation of hemoglobins, thus opening up the field of ”molecular pathology”, and of plasma proteins (e.g. the immunogloblins and the components of complement). Hemolysis in its many facets became measurable , and the big field of enzymopathies (e.g. G-6PD- deficiencies) opened up. Coagulation was investigated with relatively crude methods, which were however sufficient for the clarification of many congenital disorders.
A therapeutic breaktrough was initiated by Farbers description of a growth inhibiting effect on leukemic cells by aminopterin (1948). Pediatricians became pioneers in the treatment of acute lymphatic leukemia, and this was one of the first steps for the later expansion of oncology.
In 1952 congenital agammaglobulinemia was discovered as a frrst example of the Primary Immunodeficiency Syndromes (PIDS), which were described in rapid sequence in the following years. It was the opening signal for the vast field of Clinical Immunology with Translantation Medicine as one of its most expansive sub-topics. Here as well pediatricians were leading in the development of bone marrow transplantation (BMT).
Since many of these diseases occurred in families, the interest in human genetics was greatly stimulated.
In the mid-sixties cytochemistry seemed promising for the classification of leukemic cells. Unfortunately not very much was retained of it after careful prospective studies, but the next step, immunocytochemistry turned out to be much more successful, especially since the introduction of monoclonal antibodies enabled the ad libitum detection of virtually every antigenic structure. A great leap forward was the realization of scanners with the capacity to count thousands of cells within a few seconds (instead of a few dozens in half an hour with the fluorescent microscope), which yields meaningful differentiations of malignant cells.
Finally, the introduction of methods based on molecular biology into clinical laboratories enabled both an increase in specificity and a reduction of sample size by several orders of magnitude. This phase of rapid growth continues with the promise of further enormous increase in knowledge, hopefully followed by new therapeutic approaches.


 2.2.  Consequences for pediatric hematology
This enumeration, far from being complete, served to demonstrate the profound changes in the life of a hematologist: his old microscope has been supplemented by a large park of highly sophisticated instruments. Their correct handling is only possible with the help of skilled collaborators. This expansion of hematology in terms of specialists and of lab-space went along with a gain of influence in the hospital community.
On the other hand, expansion occurred also in other subspecialties. Competition for power, personnel, lab-space and financial resources grew enormously. In particular two fields are now struggling with hematology, namely oncology and allergology. Both of them can claim to exhibit immediate practical importance in the care of sick children, to be rather successful, and to have mobilized large funds of money for scientific as well as charitable purposes.


3. Foundation of the ESPHI

3.1. Preliminary discussions.
Most of the members in the European Club for Pediatric Research were engaged in metabolic and endocrinological problems. Competent partners for discussion or collaboration on hematological problems were rather found in the national and international Societies of Hematology. There, however, only few people were pediatricians or able to appreciate the special problems encountered in children’s hospitals. A solution was attempted in InternationaI Meetings by the organization of special pediatric sessions in the Hematology Congresses, or vice versa an afternoon for Hematology during a Congress of Pediatrics. These symposia or workshops, however, often exhibited repetitions of established work, and not the presentation of new, original findings; they could’nt satisfy the young people.
Other subspecialists met identical problems: neurologists, gastro-enterologists, nephrologists and others started to gather in small circles, some of which soon developed into well-organized Societies, all of them with the prefix ”European Society of Pediatric ... ”. It seemed therefore appropriate to some of us to try the same in hematology.
The new Societies attempted to find an optimal balance between the ”horizontal” attitude of the pediatrician keeping in mind the age-related developmental aspect on one side, and on the other hand the ”vertical” approach of the pure subspecialist, for whom the technical problems in his field (e.g. biochemical reactions) are identical in all age groups. 


3.2 First ESPHI meeting 1969.
In this situation, a handful of active hematologists undertook a tentative reunion of a ”Working Group for Pediatric Hematology” under the auspices of the ”Club”, now the unrestricted ”ESPR”: during its first open annual meeting of 1969 in lnterlaken they invited those possibly interested in the goals outlined above. The ESPR-president, Ettore Rossi, was particularly concerned with the danger that pediatric research might disintegrate, and he encouraged meetings of subspecialties under the common roof of the ESPR.
The success was unequivocal, and the 70 participants at the first Business Meeting (chairman: Schafer, Hamburg) decided to go ahead by founding a new Society. Long discussions were devoted to its scope and structure. Hematology was in an expansive development: in addition to the traditional morphologic study of blood cells and their diseases, new fields of active research considered their physiology and biochemistry, the plasmaproteins and the immune reactions. In leukemia pediatricians achieved amazing therapeutic results. This field, which soon expanded to the new ”oncology”, had however already founded its own subspecialized Society called SIOP (French: Société lnternationale d’Oncologie Pédiatrique) which since its beginnings was not restricted to Europe, but had international ambitions.
The goals of the founders of ESPHI were dictated by the practical circumstances: all of them were working alone or with only a few collaborators, but they had to supervise all the services connected with hematology in large children’s hospitals. The still quite modest activity of Clinical lmmunology was induded, also in the name. Oncology was not exduded, since all the hematologists had to serve as consultants for these patients as well.
There was, however, a very serious objection against these plans: the prominent French hematologist Jean Bernard found it to be counterproductive against the unifying endeavors of the International Society of Hematology which had just fused with the European Society of Hematology in order to reduce the number of meetings. His objections were well considered and largely discussed, but finally rejected by the 1969 Business Meeting.


3.3. First Constitution of ESPHI 1970.
A small Committee was charged with the elaboration of a Constitution to be discussed and approved at the next meeting in 1970. Leiden was chosen as the official business address of the Society, mainly for legal and financial reasons. Most of the regulations of ESPR were adopted without change; one important exception was the unlimited age of admission for new members (ESPR later also dropped the age limit of 45 years).
The Constitution was adopted unanimously at the second Business meeting in Stockholm by the 40 founding members, with Sjolin as chairman. It was left unchanged until 1990, when minimal corrections seemed necessary concerning the rights of emeritus members and the existence of ESPHI ”now for an unlimited period of time” against ”29 years 11 months” in the frrst version.



4. Activities of ESPHI
Since the foundation, biannual meetings were held, each time in an other town. The intention to have frequent joint meetings with other European Research Societies turned out to be more difficult to realize than anticipated: planning must look several years ahead, many other meetings may interfere, the congress calendars are notoriously overcrowded, financial resources are limited, and the difficulties to find hotel and meeting rooms increase in a logarithmic scale with the number of participants. Joint meetings were held in 1969 and 1970 togethter with ESPR (as mentionned), in 1972 with ESPGAN in Hamburg (chairman: Schafer), in 1974 with SIOP in Genoa (chairperson: Luisa Massimo) and in 1981 with ESPR and several other Societies of subspecialists in Bern (chairman: Herschkowitz). Just this last meeting clearly demonstrated, how difficult it is to host so many people with disparate interests simultaneously. The question was asked, whether real contacts between different specialists had occurred, and therefore whether the effort was in reasonable relation to the effect.
ESPHI’s Constitution states in art. 4 a) that regular meetings are scheduled every second year, thus respecting the wish of the International Society of Hematology to restrict the number of congresses. Due to a change of schedule (to even years) of the ISH, however, our meetings happened in the same year. In 1976 we decided therefore to shorten our interval twice to 1 1/2 years in order to change to the odd years, thus intercalating with the ISH-meetings in the even years. An exception to this schedule became necessary in 1991 because the Board felt that the lraki-Gulf-War made flight-connections with Ankara insecure and therefore postponed the meeting to June 1992., returning to the regular schedule with the Olliu-meeting in 1993.


4.1. Business Meetings
BMs were held biannually according to the Constitution. They served for the statutary business as Reports of President, Secretary and Treasurer, elections of Board members and of new Members of the Society and discussions on the future meetings.
More fundamental discussions on vital problems of the Society took place in the Council meetings. They were held at the convenience of the officers, sometimes during other congresses attended by all of them, sometimes on special invitation, e.g. in Leiden.
Table 2 is a list of the officers during these years. Table 3 shows the number of members. A commemoration of deceased prominent members is added.


4.2. Scientific meetings
The center of the biannual meetings were clearly the scientific sessions. The chairpersons were free to chose a main topic and to invite key-note speakers, often outstanding scientists of the local universities. In addition, every member or one of his/her guests was entitled to present free papers relating to their recent work. This possibility provided to many young research workers a rostrum for their presentations to a competent audience who could give them constructive criticism and encouragement. In 1977, the first Poster Session was held; this possibility of communication proved to be useful and was much used and expanded in the following years. Publication of the abstracts was always possible: they were printed in ”Z.f.Kinderheilkde” from 1970 to 1974, in ”Ped.Res.” from 1976 to 1981, and since 1983 in the ”Europ.J.Pediatr.”. Concerning publication of the full text of the presentations and possibly also of the discussions, there were, however, always conflicting opinions: those who felt, that oral presentations should differ from papers to be read, were opposed by those who wanted to make ESPHI known also to foreign readers by extensive proceedings. The decision, however, was not ours, but dictated by the lack of financial resources: several Journals announced some interest in such a publication, but the price would have been at least 150 subscriptions to that Journal by ESPHI-members. This condition was never met. In retrospect, I don’t think that this is regrettable, because certainly every piece of good work was published on its own in an established Journal, where it probably found a wider audience than would have been the case in the bulk of ”Congress Proceedings”.
Even a superficial look at the main topics chosen by the chairpersons of the biannual meetings mirrors the briefly outlined evolution of our science, and at the same time shows that the Society was usually up-to-date. A few examples may sufficiently prove this statement: 
-Bone marrow transplantation (BMT) for the curative treatment of congenital immunodeficiencies, especially the SCID-syndromes, was discussed already in 1969 (the frrst successful BMT was performed in 1968 by Good and Gatti in Minneapolis), and this topic reappeared in all the following years.
- The immune reaction and its disorders were, of course, standing subjects, in particular the Primary Immunodeficiency Syndromes (= PIDS).
- Already in 1985, the manifestations of AIDS in children filled one of the main conferences.
- Developmental aspects of hematologic as well as immunologic parameters and diseases and the findings in the neonatal and perinatal periods were carefully studied with ever renewed methods.
- For purely theoretical talks competent specialists, usually working at the University hosting the meeting, were invited as guest speakers.
lt becomes obvious from that the number of invited speakers increased steadily as an indication of the rising number of new fields of research. 
A last remark in respect of former discussions may be devoted to ethical aspects: in earlier years, many blood parameters were measured in populations of normal infants and children, but apparently nobody cared about consent and information of parents or children. Some of the normal dates worked out by such studies are stili used today, and it would be much more difficult to get them now. However, a study on ”The effect of blood glucose level on oxygen consumption .... in newbom infants during exposure to cold” (presented elsewhere) would hardly be accepted for public presentation in a scientific meeting to-day, not to speak-of providing the financial funds to perform it. One should, however, remember that around this time (1969) prematures were deliberately cooled in order to slow down their metabolism, a procedure suggestively called ”hibernation”. Such flash-lights on certain episodes in the history of medicine may teach us to be modest and critical conceming alleged ”progress”, and always to respect the integrity of our patients.
To finish this episodical paragraph on the scientific activity, the newer initiative of our present Secretary Prindull should be pointed out, i.e. to send ”Newsletters” to the members. They inform us about new developments and arrive in irregular intervals, according to the needs of the occasion.


4.3. Cooperative studies
One of the intentions of the founders was the encouragement of cooperative studies amongst ESPHI-members. It seems disappointing, that such working parties have barely been formed. The example of SIOP and other oncology groups shows the potential of this type of collaboration, but also the enormous demands for personnel, infrastructure and money.
The contacts with SIOP resulted in the nomination of liaison-officers on both sides: since 1987 our secretary Prindull is connected with the board of SIOP, and reciprocally SIOP sends as an observer their member Philip to ESPHI. Obviously, however, the interest of the much more powerful SIOP in the activities of her little sister ESPHI is quite limited.


4.4. Social events
Were always included in the program of the biannual meetings, but they never predominated over the scientific sessions. Usually one dinner party with some entertainment and dancing was scheduled. Concert or ballet performances and receptions by govemment or university representatives gave each meeting some local splendor. Programs for accompanying persons were offered by the local committees.
Post-congress tours were optional; for me the guided tour through Israel after the meeting in Caesarea and the bus tour from Oslo to Bergen and back on the famous mountain train are unforgettable, both for the exterior impressions and for the possibilities of intensive discussions and cultivation of friendships.