Child's Nerv Syst (1996) 12:234-241 9 Springer-Verlag 1996

C o n c e z i o Di R o c c o

The significance of an international society

Presented at the XXIII Annual Meeting of the International Society for Pediatric Neurosurgery, Santiago de Chile, 1995 C. Di Rocco Section of Pediatric Neurosurgery, Catholic University Medical School, Largo A. Gemelli, 8, 1-00168 Rome, Italy Fax: (39) 6-30 51 343

Introduction

The greatest honor I have received in my scientific career is undoubtedly that of having been elected President of the International Society for Pediatric Neurosurgery. I am deeply grateful to all of you, my colleagues and friends, for this recognition. However, the pride associated with this position has been only a relatively small component of the emotions that have influenced my reflections during this year of my Presidency. In fact, the main feeling I have is the desire to answer some basic questions concerning the essence of our Society itself. What is the real justification, nowadays, for the existence of scientific societies in general and of the International Society for Pediatric Neurosurgery in particular? What is its purpose in an age when scientific communication can count on such effective tools as journals, fax, electronic mail, teleconferences, and international computerized networks, such as Medline and Internet? Most of these communication systems are easily accessible to a large number of users through the world; all of them are certainly less expensive than travelling to attend scientific meetings. In other words, why do scientific societies still flourish nowadays, and why do we still need them? What is the point of being a member of a scientific society? What personal contribution can we make that will benefit our colleagues, and conversely, what advantage do we gain from our acquaintanceship with them? Is such an advantage so

precious as to justify regular meetings, especially when such meetings are held in countries that are so remote for many of us, for example, Chile, the beautiful country hosting the present meeting? It would be easy to react to these questions by simply stating that we enjoy meeting our colleagues because we share a common interest and speak the same language. A more exhaustive answer, however, would require deeper research and analysis of the experiences of other human beings who have explored the vast field of scientific knowledge before us. Unfortunately, any analysis I can make is far from being exhaustive; consequently, my answer is necessarily limited, conveying only some of the various motivating factors on which the existence of a scientific society is based. In particular, the true comprehension of the nature of our International Society for Pediatric Neurosurgery would require the ability to understand the various cultures that meet and interreact in our relationship with each other. Unfortunately this is not something I can have; on the contrary, the feelings I can express are exclusively those of a European man, or more correctly, of an Italian.

Travel as a motivating factor

The need to travel can be regarded as an "inborn" characteristic common to Europeans. Indeed, according to mythology, European civilization originated in Crete from the incessant wandering about of Europa's brothers in search of their sister. Europa had in fact been abducted by the king of gods, Zeus, under the aspect of a white bull because of her most appealing beauty. Clearly, the myth reflects one of the main characteristics of European civilization, that is to say the continuous commercial and intellectual exchanges among the various populations, from which Europe has derived its specific culture. It is not by chance that Crete was chosen as the first European seed, as this island might legimitately be re-

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garded as a part of Europe, Africa, or Asia, or preferably as the point at which these three continents meet. If travelling, exploring, exchanging is part of being European, medical knowledge is by definition a migratory curiosity. The medical field is, in fact, an incessantly fluid intellectual landscape, which requires continuous mobility of its explorers and inventors. Hippocrates, the father of medicine in the fifth century B.c., left his native island of Cos to settle in Thessaly; he spent a large part of his life travelling before his death in Larissa. Before Hippocrates' time, Democedes of Crotone, the son of a small town in Southern Italy, had cured Darius and his wife Atossa and found fame in Asia. Cos was actually the exporting country for medicine, and its physicians cured the entire world of the time. Apollinides was physician to Amytis, the sister of the Persian king Artaxerxes I. Ctesias was Artaxerxes II's doctor and wrote an important history of Persia, the Persica in 23 books. The tradition continued into more recent times, as demonstrated, for example, by the celebrated report written by the Parisian Charles Plantin on his travels in central Europe, published in 1676, and the descriptions of the Great Mogul Empire by the Italian Nicolao Mannucci in the XVII century and the French doctor Francois Bernier in 1711 or that of the Japanese empire by the German Engelbert Kaempfer in 1732. Critoboulos of Cos cured Philippos, the king of Macedonia, when he was wounded in Methon (354 B.C.). Crisodemos of Cos accompained Alexander the Great on his trip to India in 326 B.C., and Thessalos, one of Hippocrates' sons, followed the Greek expedition to Sicily. Galen spent the first four years of his medical education in Pergamon, continued his studies in Smirnes and Corinth, and settled in Alexandria in 152 and then in Rome in 162. The association of medicine and travelling can be seen in the Roman epigraphs of dead physicians. Among the qualities attributed to a physician - good husband (marito bene merenti, C.I.L.2,4313; coniugi optimo, C.I.L.2,2594), good father (patti pio, C.I.L.2,3666; patti suauissimo, C.I.L.6,9606), good son (filio carissimo, C.I.L.6,9578), good brother (fratri piissimo, C.I.L.6,9599), virtuous man (medicus pius, C.I.L.8,12922; amico bene merenti, C.I.L.6,8896; homo bonus,C.I.L.8,12153), expert professional (medicus interprimos, B. Arch. Stor. dalm. 24,1901, n. 288; medico rarissimo, C.I.L.8,8498; laudabili viro medico, C.I.L.11,2835; artis medicinae doctissimus, C.I.L.2,4313) - experience of travelling and knowledge of the world are in fact regarded as a distinguishing characteristic of medical persons (medicus fora multa secutus, C.I.L. 11,5836; ~o)~)v 0c0~&cJcmcv~c~tTc~c~v~ptvo(YvflGc~ [he has travelled a lot by land and sea], I.G.9,2,1276, rtoZ)~v dvSpcbv ~ 8 o v dozeo~ ~:o~v6ov ~yvo3v [he has visited many towns and several peoples and known their way of thinking], I.G. 12,8,450). In the ancient world, medical knowledge emanated from sacred sources, such as the great Egyptian sanctuaries or

the Greek temples devoted to Apollos, his son Asklepios and his grandaughters Igea and Panacea. These were the places where the sages of the time were wont to meet for the purposes of communication and learning. A learning stage spent at these renowned temples and sanctuaries, or at least a visit to one of them, was regarded as an essential step in every physician's education. Two thousand years later, a similar attitude can be observed. In the nineteenth century and in the first decades of the present century, in fact, a medical pilgrimage to universities and hospitals that had gained an international reputation as modern temples of scientific wisdom by virtue of the intellectual acquisitions and discoveries made by scientists working there was practically mandatory for anyone wishing to acquire an excellent and "complete" medical education. In recent years, medical instruction has tended to become specialized for many of us. This tendency is at the basis of a phenomenon that may devalue a stage that is limited in time or confined to only one place in medical education. The ,,sacred" places of medical knowledge have, in fact, become significantly more numerous than in the past; however, their life as sacred places has become rather ephemeral, being nearly always strictly related to that of their leading scientists. The excessively high number of scientific centers worthy of being visited actually restricts the effective exchange of information allowed by the physical mobility of an individual researcher. On the other hand, the unstable and migratory life of most modern scientists means there is no obvious choice of where a young doctor should spend the short period of time usually available for learning experience abroad in the course of a medical career. If the essence of scientific knowledge has now become unstable, attendance at scientific meetings such as this one could be the correct response to the intellectual restlessness that characterizes contemporary scientists and is probably the one sentiment that most of us have in common. Among the justifications I see for the existence of a scientific society, the need to communicate and interact undoubtedly has a predominant role. Although medical science has historically indulged in claiming a kind of "arcane" nature for its acquisitions, it has also always been attracted towards the mediatic forum. In the same way, its initiates, even while apparently feeling the need to guard their own experiences jealously, have also felt the continuous need to confirm the value of their discoveries by exposing them to their colleagues' opinions. Besides offering an effective forum, scientific societies provide an immediate relationship between researchers, which is necessary for recognition of even the smallest advances made in laboratories that are far distant from each other. Scientific curiosity and the desire to challenge one's own and others' convictions, in other words the need to learn, improve, confront and discuss ideas, probably pro-

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vides the strongest motivation for a scientist to participate in the life of a scientific society. Indeed, even now, such societies remain the trustworthy instruments for self-improvement depicted by Osler at the beginning of the century: "The Medical Society is the best corrective, and a man misses a good part of his education who does not get knocked about a bit by his colleagues in discussions and criticism." A further motivation that prompts groups to band together in scientific societies coincides with the existential need for recognition as an individual and the simultaneous desire for reassurance that belonging to a cluster of similar individuals brings with it. Scientific societies provide both recognition and reassurance. They establish admission criteria, they recognize members, they defend prerogatives, they oppose baneful individualism, and, to a certain extent, they define professions. To emphasize these aspects we can once more quote Osler, specifically his description of the impact of newly formed professional medical societies on the medical establishment in the United States at the end of the last century: "The organization" of Societies for the study of particular diseases has been of late a very notable feature in the professional life of this country .... These societies stimulate work, promote good fellowship, and aid materially in maintaining the standard of professional scholarship. They are nearly all exclusive bodies, limited in membership, and demanding for admission evidence of special fitness. This point is sometime urged against them; but the members excercise no arbitrary privilege in asking of candidates' familiarity with the subject, and evidence of ability to contribute to the general store of knowledge."

Scientific societies as a place for free discussion and expression of ideas

It is somewhat stimulating to consider that the factors that motivated the establishment of contemporary scientific societies are the same ones as determined their origin under the form of the academic movement, which, having arisen in Italy during the Renaissance, diffused through all Europe to influence the whole of Western civilization. The prehistory of the scientific societies goes back to Florence, during the fifteenth century, when the humanists, and in particular Marsilio Ficino, Poliziano, Pico della Mirandola, felt that free discussion among intellectuals sharing a common spiritual attitude could serve the interior discovery of the truth better than the formal and unchallenged teaching ex c a t h e d r a provided by the universities. In 1462, under the official patronage of Lorenzo il Magnifico, Marsilio Ficino founded the Accademia Platonica, so called after Plato's famous philosophy school in

Athens in the gardens of the rich citizen Akademos. This initiative was soon imitated in other Italian towns, for example, Venice, where Aldo Manuzio founded the Accademia dei Filelleni. The first academies were mainly devoted to the study of philosophy and liberal arts, with the aim of escaping the strict doctrinaire control exerted by the adherents of Scholasticism, the leading philosophy in the Middle Ages. However, the right to organize their own academies was soon vindicated by various groups of scholars and also by several arts and crafts gilds. At the end of the sixteenth century there was an explosion of academies in Italy, as each domain of knowledge seemed to require a specific course of study: the Umidi devoted their activity in Florence to the codification of the Italian language; in the Vatican the Accademia delle Notti discussed theological questions; in Siena the Rozzi and the Intronati and in Vicenza the Olimpici addressed their interest to the theater; in Verona the Filarmonici devoted themselves to music. In 1530 there were more than 500 academies, including 70 in Bologna, 56 in Rome, and 43 in Venice. The characteristics of these academies, however, were very different from the rather simple but enthusiastic circles created by the intellectual ardor of the learned scholars of the early Renaissance. Indeed, the pleasure of intellectual discovery and the didactic fervor that had arisen out of reconquered intellectual freedom were gradually replaced by zealous and organized research, by the desire to order the various fields of experience in a formal way, and by the burocratic defense of particular interests. Such a change in attitude was undoubtely favored by the political powers of the time, in the same way as in the domain of the visual arts the revolutionary invention of new forms and styles of the early Renaissance had been encouraged to yield to the more rigid and formally organized M a n i e r a . At the beginning of the sixteenth century, practically all the academies, even those that were esoteric and secret, had a similar model of organization. They were chaired by a prince, assisted by various censors; their activity was based on meetings held at regular intervals and regulated by a specific statute. All together, however, these academies constituted a formidable intellectual organization, with branches extending all over the Italian peninsula and with no respect for the borders of the single states into which Italy was divided at that time. Furthermore, as most scholars were members of more than one academy in different Italian towns, the academies contributed very effectively to the circulation of educated people and to the diffusion of their ideas.

The scientific society as a "political" body

All scientific societies require the fulfillment of specific admission criteria.

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Recognition of the characteristics defining the intellectual and practical interests and a particular field of action common to those to whom membership is open is, in fact, the only way a society has of defending the professional image of its members. The more strict and precise the admission criteria, the more effective are the political influence and the joint role that a group may eventually exert. Even this function of recognizing professional images and defending their practical interests finds its first expression in the Renaissance academies. Once more Florence was the forerunner. The GrandDuke of Tuscany, Cosmo de' Medici, offered his protection to the Accademia degli Umidi, which was devoted to the study of the Italian language, changing its denomination to Accademia Florentina. He understood, in fact, the role that the Accademia could have in promoting the Italian language (actually the Florentine dialect) and imposing it as the common language to be spoken throughout the Italian peninsula. The Accademia held regular private and public meetings and was integrated into the university system; its Consul became the dean (Rettore) of the University itself. The risks inherent in the centralization of the academic movement, especially the limitation of intellectual freedom, did not escape a minority of erudite scholars, who later (1582) resigned from the Accademia Florentina and founded a new academy: the Accademia della Crusca. When painters and sculptors asserted that technique must be subordinated to creativity in order to separate fine arts from the "mechanical arts" and to relax the rigid medieval statutes that confined them to the craftsmen's gilds, the duke of Tuscany gave the artists practical and concerned help. In 1563 Vasari was able to found the second academy in Florence to be supported by the Medici, the Accademia del Disegno, which institutionalized the professional academic purposes of the artists of the time. Thirty-six artists, chosen from the most prominent personalities of the city, were selected to be the first members of this academy, whose presidents were the Grand-Duke Cosmo de' Medici himself and Michelangelo. In 1571 a decree inspired by Cosmo de' Medici embodied the painters' and sculptors' independence of the medieval craftsmen's gilds and recognized their activity as a specific art, consequently inaugurating what Vasari triumphantly defined as "Tempi Moderni" Besides defending the interests of the artists against the craftsmen's gilds, Vasari was of the opinion that the academy should promote the intellectual dignity of the visual arts by providing formal teaching in general and technical education. Some teaching courses were actually held, mostly devoted to mathematics. It is worth noting that the organization and the purposes of the Accademia di San Luca, founded in Rome in 1588 by the cardinal Federico Borromeo and the painter Federico Zuccari, were quite similar; however, the initial ab-

sence of a direct involvement of the Pope made this academy considerably less influential than its Florentine sister institution in limiting the powers of the medieval corporations. The teaching program of the Accademia di San Luca was aimed at forming the genius universalis and consisted of the study of the 'belle arti' (painting, sculpture, and architecture) with courses in history, composition, and anatomy as well as practical activities, namely the study of the "vero" (the nude), and copying the classic artists of Antiquity and the "grandi" painters of the Renaissance, especially Raphael. The Accademia di San Luca served as a model for all the European artistic academies until the creation of the Acad6mie Royale de Peinture et de Sculpture in Paris in 1648. The function of defining a "profession", first exerted by the Accademia de Disegno, remains one of the most important purposes characteristic for the majority of modern scientific societies. Such a function becomes paramount when the institutions of society, in its wide sense, do not yet perceive or do not intend to perceive the need for a given profession. In various countries, pediatric neurosurgery is facing the same process as has characterized the initial development of other medical subspecialties, namely lack of recognition by university or hospital authorities and subtle or overt opposition by the parent specialty; and for this reason I feel that the function of advancing professional recognition is currently the most significant feature of our Society. In some instances, it is only the recognition accorded to our Society that enables us to affirm ourselves as pediatric neurosurgeons in places where the specialty is not yet formally recognized.

The scientific societies as an organ for verification and diffusion of scientific advances

The scientific nature of the International Society for Pediatric Neurosurgery finds its most direct expression in the organization of the Annual Scientific Meeting. As the Society accepts as members both practicing neurosurgeons and research scientists, the meeting's scientific program includes both sections on basic sciences and sections in which clinical experiences are reported. In choosing this type of organization, we are again following a traditional scheme elaborated some centuries ago by the first scientific academies. It is difficult to establish the moment at which the disciplines devoted to the study of nature became really scientific, losing their ballast of unproven truths, worthless beliefs, and "magical" influences. For the same reason, it is quite impossible to identify the first "scientific" academy, as several groups inclining to the scientific observation of natural phenomena to varying degrees were formed

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in the period of the second half of the sixteenth and the first half of the seventeenth century. In the early phase of their development, most of these groups were "social islands" of a sort, each based on an elitist organization with its own initiation rites and cryptic ceremonies. In 1560, in Naples, Giambattista della Porta founded the Accademia Secretorum Naturae, the first academy at which medical sciences were investigated. Giambattista della Porta was the author of a medical theory influenced by alchemy and magical elements, similar to that propounded by Paracelsus. Astronomy was also studied at the Academy of the Secrets, and it was here that the first experiments on binoculars, dark-room work, and the magic lantern were performed; in addition, the first rudimentary thermometer was developed here. The first academy with a declared scientific intent was the Accademia dei Lincei, which was founded by Federico Cesi in Rome in 1603; besides Giambattista della Porta (mentioned above), its founding members included Galileo Galilei and foreign scientists, such as Faber and Holstein. The main goal of this academy was renewal of the sciences based on experimental research and the rejection of any supernatural element. The Accademia dei Lincei was not a scientific organ in the current technical sense, as the scientific research it effectively carried out was only a part of a complex project of self-improvement, with aspects reminiscent of the lay monastic organizations. In spite of Galilei's affiliation, the interest of the academy was addressed to the study of "objects" rather than "facts". However, the influence of Galilei was of paramount importance for the adoption of the microscope, in which the academy had a pioneering role in early investigations on microscopic anatomy. The Accademia dei Lincei did not differ from the other academies in its practical organization: experimental observations were not performed during the academic sessions, but were rather conducted privately; during the academic sessions only the results were presented in the form of a "lecture", which was sometimes followed by a discussion. If we keep this type of organization in mind, it is possible to understand the truly revolutionary step taken with the creation of the Accademia del Cimento by Grand-Duke Ferdinando II dei Medici and his brother Leopoldo in Florence in 1657. The academy was the first to introduce Galilei's method of experimental research into academic practice. The initial magic characters were eliminated completely; scientific observations were separated from philosophical ideologies; the elitist self-improvement projects were abandoned; and the researchers' interest shifted from the objects to the facts, meaning phenomena that could be evaluated and represented by mathematical relationships and models. The Accademia del Cimento was the first institution to deny the previously assumed unity of philosophical and scientific knowledge; this was reflected in social life by

the disappearance of the omniscient scientist, the figure typical for the Renaissance. The academics gave up the heady moments of revelation in the lecture room, and the research was performed inside the academy itself, which consequently became a kind of laboratory. Both the academy motto: "Provando e riprovando" [testing and testing again[ and the logo, three simmering pots over a burning fire, symbolizing experimental research, emphasize the direct involvement of the Accademia del Cimento in experimental investigation, in contrast to other contemporary academic institutions. Although the Medici family had made a special contribution to the academic movement by founding the three great Florentine academies, the Accademia Florentina for literature, the Accademia del Disegno for the arts, and the Accademia del Cimento for the natural sciences, their action was necessarily limited by the small dimension and the relatively small economic resources of their state. Consequently, the academic movement was not able to develop fully until it was accepted by the great states of Europe: England and, especially, France. The price of this development, however, was even stricter political control. The English contribution was mostly in the scientific field. In 1662, Charles II gave his protection to the scientists of the Royal Society of London, founding the Royal Society. This protection was essentially political, as the state of the royal finances precluded any significant economic support for the newly formed academy. Consequently, for some years, the Royal Society maintained an amateur character. On the other hand, the Acad6mie Royale des Sciences, which was organized four years later in Paris by Colbert, was provided with a large financial subsidy from its inception, as well as official recognition. Indeed, this academy was only a part of Colbert's vast academic program, which was aimed at developing French cultural life under strict State control and at placing France at the head of the civilized nations in Europe. The French academic program was actually based on three main demands: the necessity for exalting the monarchy, the demand for an intellectual order that could equal that of ancient times in the domains of the letters and the arts, while being superior in the domain of the sciences, and, finally, a commercial exigency. The last had an important role, especially, for the Acad6mie des Sciences. The main reason behind Colbert's patronage and financial support for what had hitherto been only a spontaneous association of amateurs was the desire to favor the discovery of technical inventions that would be likely to put the French manufacturers in the best position to compete with foreign factories. The academy served as a kind of office for the recognition of patents. In 1669 it organized a true inventory of the scientific knowledge of the time, which was described in publications accessible to the public. Every week the discoveries were published in the Journal

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des Sfavans. In addition, the academy published an annual book, which was addressed not only to specialists but to all educated people, entitled "Histoire et mdmoires de l'Acaddmie royale des sciences". With the French academies, the academic movement reached its apogee: the Acaddmie des Sciences was, in fact, the leading body in research and, at the same time, an important instrument in education, preparing for the scientific development of the next century, which was dominated by Illuminism. This is probably the moment at which the State first became convinced of the vital importance of science for the progress of its citizens, and the first moment at which the arts abandoned the cultural hegemony they had exerted since the Renaissance. The institutionalization of the academies in France, England, and other European countries caused a profound change in the very nature of the academic movement. The academies renounced any ambitions in the directions of self-education and self-improvement, which had moved the earliest intellectual circles of the Renaissance, and abandoned the idea that the word institution meant one solely for research, which was the great innovation introduced by the Accademia del Cimento. With a predominantly "traditional" cultural atmosphere, the academies acted as organs for registration of the advances made by a constantly growing scientific community rather than expressing the views of illuminated minorities; their judgement became the state's official mark of recognition in the sciences. In the period extending from the second half of the eighteenth to the first half of the nineteenth century, a period of continuous political and administrative change in Europe, the academies maintained strict integration with the political powers, accentuating their transformation into instruments for the official and social recognition of eminent state personalities. Among the academics, the number of true researchers tended to decrease, so that many academies were compelled to introduce the distinction between effective and honorary members, following the example of the Royal Society and the Accademia delle Scienze of Bologna. Nearly always, the most eminent researchers among the academics were university professors and performed their research in university laboratories and anatomy rooms. In the second half of the eighteenth century, the university structures in Europe faced a far-reaching reorganization: the universities assumed the responsibility for basic teaching, while the academics became the institutions in which the ultimate scientific acquisitions were presented and discussed. Some academies, especially in the small Italian states, reacted to the full institutionalization of the academic movement by intensifying their scientific activity or by creating new scientific sections to preserve the role of outside support and thus safeguard progress in the sciences. For example, the Accademia degli Inquieti in Bologna was

founded exclusively by researchers and gave up all mundane teaching work. In the same town, 1782 saw the founding of the Accademia dei XL, which was completely private and refused any political support. This academy recruited members from the entire Italian peninsula and introduced qualitative admission criteria that were highly selective (hence the humerus clausus, which gave the Accademia its name) in order to exclude any nonscientific modalities of enrollment. In an academy of this type any opportunity for ceremonial practices was averted by its extremely specialized character and by the physical distances between its members, who were distributed over the entire Italian territory. Indeed, the academy had no fixed residence, as its seat was that of the secretary (as is now the case for nearly all scientific societies). The relationship among the academics was almost exclusively an epistolary one, and their scientific activity was based on the regular publication of biannual Memoires. This is a significant change in the academy's history as the literary and rhetorical " l e z i o n e " , the main expression of the academic language in the preceding century, was abandoned for the more immediate and modern forms of scientific expression: the "memoria" and the "comunicazione". Despite the lack of political support, the activity of the Accademia dei XL went on without interruption for several decades, contributing to the creation of a unitarian concept of science among the scientific community, which now extended beyond the borders of the national states. During the French Revolution the Convention suppressed the academies, as according to Mirabeau: "there is no place for middlemen between the nation and talent". When the academies were re-established in France after the Revolution they, like their sister institutions in other European countries, tended more explicitly to an existence as ornaments of the state. They remained in essence a collection of excellent brains, and in some cases still functioned as organs for the publication of scientific experience. In nearly all cases, however, the academies indulged almost exclusively in contemplation of their glorious past and the defense of their relics and old privileges. Consequently, nowadays, the adjective "academic" has undertones that are just the opposite of the connotations of progressive and dynamic intellectualism originally applied to the primitive academic organizations. Such connotations still survived in the more specialized and vital scientific societies of the nineteenth century, which in several cases had developed directly from academies. These societies progressively replaced the academies in their role of advance scientific verification and professional recognition. The modern scientific societies should be considered the natural heirs of the nineteenth century medical societies, and, through them, the heirs of the Renaissance academies for self-promotion and continuous research into the truth.

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The International Society for Pediatric Neurosurgery When, in 1972, some of our colleagues founded the International Society for Pediatric Neurosurgery, the main needs, which have been obvious throughout the history of the academic movement - education, organization, discussion and verification of scientific progress by a specialized audience, delineation of the professional i m a g e - , were still among the main factors motivating these scientists to found a new scientific society. These motivating factors remain valid to this day. The need our group feels to meet at an annual scientific congress is the most immediate expression of our fellowship and our desire to improve ourselves and enjoy the advantage of our colleagues' experience. Besides their scientific value, our meetings express the importance we give to being members of the same group and to the feeling of belonging to a unique international community that is not limited by national borders, spatial separation, or language differences. Our gathering also signifies the recognition we give our Society for identifying us as pediatric neurosurgeons throughout the world, and not least in our own countries. Travelling is the tool we utilize; travelling is our privilege. However, travelling in the territory of the International Society of Pediatric Neurosurgery is rarely a neutral event; on the contrary it may be a rather corrosive, albeit regenerative, process. Travelling physically, that is participating in our meetings, or metaphorically, that is contributing to our journal, exchanging information or maintaining an epistolary contact, enhances our common identity, but also our diversity. It is a process that subjects our concepts and beliefs to strain and criticism, provokes new ideas, promotes new ways of seeing and being. Travelling means disseminating knowledge, but also facing confrontation from which new convictions may originate. The scientist who travels exchanges ideas; the young person who wants to become a scientist begins with the acquisition of an idea. Our meetings are the place where advances in pediatric neurosurgery are first recorded; together with our journal, they contribute to establishment of the field of pediatric neurosurgery as a subspecialty to be taught in medical school. The meetings and our journal express the necessity for verifying the acquisitions we make in both the academic and the practical clinical areas. A process of verification derives directly from the medical societies of the nineteenth century, whose formal organization it maintains. Indeed, we still use the "communication" to present our experiences and reserve the "lecture" for our colleagues, whose specific competence we want to recognize; furthermore, the research and the clinical experience we present at our meetings originate outside our Society: in the university laboratories, in our hospitals or in our own practices. Could the International Society for Pediatric Neurosurgery still regain a role as an organ for scientific research

such as was fulfilled by some of the academies of the past, e.g. the Accademia del Cimento? As the Society has no central seat or laboratories and its members are working in different countries of the world, it is impossible to consider research projects in the strict technical sense. However, in my opinion the Society could have a specific function even in the field of research. Indeed, its international nature makes it possible for it to integrate the scientific acquisitions made by its members in different economic and cultural contexts at a superior level. The cooperative studies on neonatal brain tumors, CSF shunt malfunctions, and management of congenital CNS malformations carried out by the Education and Ethics Committees in recent years are an example of the sort of direct influence that the Society can exert in the advancement of pediatric neurosurgery. Actually, the Society could suggest problems to be investigated, delineate standards, discuss ways of managing neurosurgical diseases in children, and be the arbiter of different solutions adopted throughout the world. Probably the most relevant function of the International Society for Pediatric Neurosurgery, as for all the international societies, is currently to favor the circulation of scientific ideas. There is general agreement that such a function will also continue to be of the utmost importance in future years, consistently justifying the existence of our Society in the decades to come. In other words, ensuring a flow of scientific information appears to be the future task allocated by nature to the International Society for Pediatric Neurosurgery. Unfortunately, such a function cannot be regarded as guaranteed in the light of the contemporary changes taking place in the present organization of the scientific research. Nowadays, as in the past history of the academies, research has become the subject of state interest and control. Scientific curiosity is still encouraged, but within precise boundaries in a burocratic organization. The figures of the researcher treading a solitary path known only to him, and of aristocrats meeting for their own pleasure no longer exist. As in modern states part of the national budget is devoted to research, the force of modern science derives directly from the relationship established with the political powers that be. Universities and other research institutions have also lost part of their freedom, but have gained considerably in strength and resources. The substantial financial support currently available in many countries has made research activity accessible to a vast number of people. Research has become diffuse and has lost for ever those elitist qualities on which Merton insisted when praising the spirit of the Royal Society. The management of research is now under the control of a multitude; managers have become indispensable in raising and administering funds, and in suggesting and establishing relationships. Widely spread research generates a diffuse demand for information and circulation of ideas. Personally, I doubt whether our Society, in its present state of organization, would meet such a demand; on the contrary, I fear that the

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future reserves for it only a marginal role. Modern scientific rotation, in fact, is directed at places that ensure rapid exchanges among numerous specialists and contacts lasting considerably longer than is allowed by scientific meetings. The sites of modern communication - research centers, libraries, data bases - are going to be accessible 24 hours a day. They are already internationally available by virtue of the numerical transmission of information. The accessibility to and, on the other hand, the control of these sites will create a new hierarchy among the various research centers. The phenomenon is already visible on consideration of the current organization for scientific innovation based on electronic transmission networks centered on the United States. The implications of such a phenomenon deserve particular attention from our Society and other international scientific societies. Nowadays, researchers tend to become directly responsible to the state (or other sources of financial support) because of their economic dependence; their acquisitions belong primarily to the state, which demands the right of exploiting their economic potential. Researchers are used to letting businessmen take advantage of their discoveries, but until now, they have succeeded in defending their right to intellectual property. Will the above be true in the future? At the m o m e n t , as science still claims to be universal, the scientific acquisitions that originate as the product of a nation rapidly become international. Consequently, as in the past, the international societies may continue to be regarded as important instruments in the internationalization of scientific progress. In order to retain such a function in the future, however, they probably should adapt to the new form that scientific circulation, based on international networks for the transmission of information, will assume in the coming years. They must oppose any nationalization of science and any obstacle the single states or private organizations might possibly create to the circulation of ideas or to the accessibility of the sources.

Some academies of the past, e.g. the Accademia del Disegno in Florence, were founded so that the rights of groups of specialists could be recognized and defended. As mentioned above, such a function has been exerted by our Society simply because it exists. There is no doubt that without the International Society for Pediatric Neurosurgery the care of children with neurosurgical diseases would not have received the special attention that has been paid to this branch of medicine and the specific knowledge required could not have been so clearly defined. In other words, practical recognition of the pediatric neurosurgeon in the world is one of the most significant attainments, albeit an indirect one, of our Society. On the other hand, the process of formal recognition of the pediatric neurosurgeon as a separate professional has been positively and fully developed in only a few countries. Nevertheless, in the last few years, important steps have been made in this direction: in the United States, for example, the process of a formal separation of pediatric neurosurgery from general neurosurgery has been pursued through the institution of a fellowship and board certification; in Europe, pediatric neurosurgeons are working together with the UMS (Union de mddecins sp6cialistes) to have their profession formally recognized in the European Community. In my opinion, it is time the International Society for Pediatric Neurosurgery became directly involved in this process. The Society could, in fact, address both international and national medical organizations, promote debate among the members, individualize standards, and suggest staged solutions to be applied in the different situations such as exist in the various countries of the world. Whatever the opinion of any individual member in this regard, there is no doubt that the Society will find a stimulus for further growth or, which would be a shame, a reason for its future decline in the responses we will be able to give to such a basic aspiration. Finding the correct answers is the extremely difficult, although exciting, task we leave to our successors for the coming years.

Suggested reading Finley MI (1986) Le monde d'Ulysse. La Decouverte, Paris Gourevitch D (1984) Le triangle hippocratique dans le monde Greco-roman. Le malade, sa maladie et son m6decin. Ecole Fran~aise de Rome, Palais Farnese, Rome

Halary C (1994) Les exiles du savoir. Les migrations scientifiques internationales et leurs mobiles. L'Harmattan, Paris Ignatieff M (1994) Blood and belonging. Vintage, London Leed EJ (1992) La mente del viaggiatore. Dall'Odissea al turismo globale. Societg Editrice il Mulino, Bologna Majno G (1975) The healing hand. Harvard University Press, Cambridge, Mass Osler W (1975) Counsels and ideals from the writings of William Osler. The Classics of Medicine Library, Birmingham, Mass

Paglia C (1993) Sexual personae. Einaudi, Turin Robertson G, Mash M, Tickner L, Bird J, Curtis B, Putnam T (eds) (1994) Travellers' tales. Narratives of home and displacement. Routledge, London New York