Before 1850 international relationships in science were mostly between individuals and only marginally influenced by political events. This changed later as they progressed, and with the creation of unified nation states, sciences became more nationally oriented. It is therefore necessary, when looking at the history of an international professional society, to consider both the scientific development of the discipline to which its members belong and the socio-political situation of their respective countries which could affect them. Effective surgery developed after 1850 when it became possible to combat pain and wound infection, and over the next 70 years surgery became developed into the most active branch of medicine. As a consequence of and a precondition for this success, a number of national surgical societies were set up in Europe, North and South America, Australia and Japan. The first, established in 1872, was the "Deutsche Gesellschaft für Chirurgie". This, however, led to some estrangement between surgeons, and international congresses became necessary to establish contacts. First to be set up were the triennial international medical congresses, beginning in the 1860s. To some extent such meetings tended to conceal increasing nationalistic trends, which became manifest in medicine as in politics.

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By the turn of the century, the need for a distinct surgical international meeting was felt. Therefore, in 1902 at the congress of Belgian surgeons on the initiative of Antoine Depage and his group, with guests from France, Germany and Switzerland, it was decided to establish an international surgical society, "La Société Internationale de Chirurgie", the permanent headquarters of which were to be in neutral Belgium in part by a donation of the Belgian King. According to article 1 of the initial statutes the aim of the Society was to serve the progress of science by research and discussion. A first international congress took place in Brussels three years later.

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In the chair was a citizen of another neutral country, the Swiss Theodor Kocher (1840-1917), who was well known in Europe and overseas through his widely translated scientific work and his intensive travels. His reputation increased even more when in 1909 he received the Nobel Prize as the first surgeon. By this time the Society had 600 members of whom 200 attended the first meeting. Thus in 1905 the Société was born with its full structure and it was decided to hold the next two meetings in 1908 and 1911, again in Brussels. Afterwards the Société bravely crossed the Atlantic to meet in New York in 1914. During and after World War I, the fragile bridges of international scientific exchanncge were torn down. Thus in 1918, a conference in London of the scientific academies of the allied countries advocated the formation of new international societies, the membership of which was to be restricted to allied (and perhaps neutral) scientists. This tragic splitting up of the scientific world into political camps was a new phenomenon in the history of science. It also seriously affected the "Société Internationale de Chirurgie" which excluded members of the former central powers and eliminated German as an official language. At this moment a Swiss surgeon again became closely involved in the fate of the SOCIÉTÉ. F. de Quervain (1868-1940), famous for his work on thyroiditis and tendovaginitis, made attempts at reuniting all its members. Over 12 years he made innumerable personal contacts, involving journeys, letters and telegrams, during and between the scientifically successful meetings of 1920 in Paris, of 1923 in London, of 1926 in Rome, of 1929 in Warsaw. As president of the meeting in Madrid in 1932, he had the satisfaction of welcoming members of the previously excluded countries. De Quervain as mediator and official envoy of the SOCIÉTÉ had his work made more difficult by the continued intrusion of current events which often led to the loss of hard-won ground. Politics continued to color the meetings, first in 1935 in Cairo when the Italians invaded Abyssinia, and then in 1938 the venue has to be changed from Vienna to Brussels at the last moment because of the Germany's occupation of Austria.? After World War II the SOCIÉTÉ carefully set about reintegrating the surgeons of those nations defeated in the war; members of all countries which had diplomatic relations with the host country were at once invited nc to the meetings. Austrians and Italians, therefore, attended the first post-war congress of 1947 in London, Japanese and West-Germans that of 1951 in Paris after having been invited in 1949 to New Orleans. New questions, however, now arose from the rapid development of surgery itself, and meetings were needed every other year. Surgical specialization also developed, creating the need for new types of specialty meetings, which led to a certain loss of interest in the mother Society, especially among younger surgeons. Despite this, the number of members which had been 1500 by the late '30s almost than doubled by the mid-'70s. This was partly because many new national groups were eager for international contacts, and partly as growing conviction has arisen that surgery should survive as an unified discipline.

In the '60s a certain "unrest" became evident, particularly among overseas members who thought the Belgian predominance in the Executive Committee to be excessive. The President, the Secretary and the Treasurer were all required to be Belgian citizens, the last two coming from Brussels. They also questioned the constitution, according to which the Headquarters had to be permanently in Brussels. In 1969 at the Buenos Aires Congress, Owen Wangensteen expressed these general feelings very strongly, pointing out that all members were grateful to the Belgian for nursing the ISS/SIC through its infancy and growing years, but it was now old enough to stand on its own feet and ready for independence.

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At the International Council in 1971, Frank Gerbode and Jonathan Rhoads proposed changes in the by-laws so that no country could have a majority in the Executive Committee and that the President of the Society did not have to be Belgian. This motion was carried by an overwhelming majority. The issue of the headquarters, however, was not discussed and they remained in Brussels under the diligent supervision of Professor Jean Van Geertruyden, the Secretary General, and administered by the long-serving secretary, Mlle Bousseret. Fritz Linder not only became Congress President in 1973, but President of the Society for the biennium 1973/75.

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During these years talks were held within the Executive Committee (including at that time Henri Bismuth, Stig Bengmark, Frank Gerbode, Fritz Linder, Jan Nielubowicz and Jean Van Geertruyden) about establishing a high quality journal of the Society and eventually WORLD JOURNAL OF SURGERY was founded and first produced in 1977, under the energetic chief editor Marshall Orloff, by the publisher Springer of New York. It replaced the rather cumbersome historical "Bulletin" with its many official languages which impeded prompt publication. Fritz Linder was followed by Frank Gerbode who took a very active part in the revival of the Society which had become rather complacent and had tended to neglect the recruitment of younger surgeons in responsible position, the active membership falling back below 2000. The SOCIÉTÉ was in real jeopardy of having too many "emeritus" members and not enough "new blood". Finances also started to become precarious and in 1977/78 a sizable deficit seemed inevitable.

Belgian colleagues had up till then carried the burden of administering and leading the time-honored "SOCIÉTÉ" for over 70 years, as had been pointed out by Owen Wangensteen some 15 years earlier. It seemed mandatory, timely and fair to allow the headquarters of the ISS/SIC to be moved to other countries, if so desired by a two third majority of the General Assembly. This was then implemented in 1979 by the General Assembly at the San Francisco Meeting. To meet the requirements of the Belgian laws, the Society had to decide its own legal dissolution and to reconvene soon afterwards for its reconstitution (both decisions were made with an overwhelming majority vote). It was then decided to establish the headquarters of the Society in Basel, Switzerland. Contributions by the International Foundation for Postgraduate Surgery, made at the request of the newly elected Secretary General, and the contributions in time and effort of the Department of Surgery at the University of Basel during the years 1979-83, made it possible for the Society to meet its obligations free of charge and to make a fresh start. With a new beginning there, and the backing of the high quality WORLD JOURNAL OF SURGERY, there were grounds for optimism. The journal seemed somewhat in jeopardy after the rather sudden retirement of the Editor in Chief, early in 1981. Fortunately, James Hardy, past president of the American College of Surgeons (ACS), took over as a most efficient Editor in Chief for 2 years. When he became president elect in 1983, the chief editorship was transferred into the able hands of Samuel A. Wells, Chairman of the Department of Surgery, Washington University Medical Center, St. Louis, Missouri. After 9 years as Editor in Chief, Samuel thought it appropriate to hand over this commitment to Ronald K. Tompkins, MD, Professor of Surgery, Los Angeles, who took office after a vencry smooth transition in 1992.

The last biennial congresses have become increasingly popular chiefly due to a new format; firstly by selecting topics of general interest to all operating surgeons, and secondly by organizing meetings devoted to the various specialties and subspecialties. One such successful innovation was the creation of the INTERNATIONAL ASSOCIATION OF ENDOCRINE SURGEONS (IAES) which was founded as Integrated Society of the ISS/SIC at the 1979 Congress at San Francisco. Its members enjoy full membership privileges of the ISS/SIC like the subscription to the WORLD JOURNAL OF SURGERY, Newsletters and the biennial publication "STATE OF THE ART OF SURGERY". The IAES within the SOCIÉTÉ keeps its identity with its own secretariat and separate list of members.
At the 1989 Congress held in Toronto from September 10-16, two important items were accepted by the General Assembly. Firstly and most importantly, the "INTERNATIONAL ASSOCIATION FOR THE SURGERY OF TRAUMA AND SURGICAL INTENSIVE CARE" (IATSIC) was founded as integrated society stressing the commitment to trauma and to surgical intensive care. Secondly the thoroughly amended Constitution, eliminating former ambiguities, was unanimously accepted.

The 34th World Congress of Surgery, organized as International Surgical Week in Stockholm, with 18 participating societies, came closer than any previous one to the double aim defined above. The main components were general or specialized round tables, a few formal lectures, free papers with enough time for discussion, film and video presentations and poster sessions with discussion. Elements which have become very popular and help to overcome the usual anonymous congress atmosphere, are luncheon nc panels, with neither slides nor manuscripts, but with one moderator and two or three panelists, initiating discussion between experts in an informal way on a variety of subjects. Attendance at this International Surgical Week with free interdisciplinary contacts has increased over the last 10 years from 1000, to over 2000 in Stockholm in 1991, in Hong Kong in 1993 and in Lisbon in 1995, with some additional 450 accompanying persons. Main subjects were very much concentrated on general surgery with heavy emphasis on digestive surgery without neglecting trauma in general. This concept will be maintained despite the regrettable decision of the CICD to resume its own biennial congresses in the even years. Its participation in the International Surgical Week has, however, continued.

At the occasion of the 35th World Congress of Surgery in 1993 in Hong Kong, another most important addition to the two Integrated Societies, was the founding of the "INTERNATIONAL ASSOCIATION FOR SURGICAL METABOLISM AND NUTRITION" (IASMEN). This certainly represents another most important field of "Surgical Pathophysiology". Its input in the future meetings in terms of Free Paper submissions and in its function as critical evaluator of submissions relative to the field is most welcome.

What are the plans for the future?

The ISS/SIC would like to function with two aims in mind: on the one hand it wants to function as a very benevolent "umbrella organization" for to keep the "house of surgery" together for all problems of general interest to all surgical specialties. There are in fact such common interests like intensive care, wound treatment, shock, multiple trauma, antibiotic policy, suture matncerial and last but not least deontological problems. The ISS/SIC has also a vital interest in upkeeping general surgery as an important training base for surgery with abdominal surgery, surgery of the integuments and endocrine surgery as its "backbone", trauma as well as intensive care as a continued responsibility, shared with other specialties. The SOCIÉTÉ INTERNATIONALE DE CHIRURGIE does not visualize itself as a mass organization. It would however hope to group throughout the world surgeons willing to invest some time and energy in a quality conscious international venture. Surgeons deciding to accept this challenge will soon find out that such an engagement is intellectually stimulating and humanly rewarding.

It is hoped that with the new impetus, the oldest extant international medical society will maintain the role which has marked its first 100 years in promoting understanding and tolerance, both between associated nations and surgical disciplines. At critical stages of its history the strong belief of its SPIRITUS RECTORES in the supranationality of science and the unity of surgery has led to many fruitful personal discussions about important surgical attainments of the last 90 years in 24 cities of 5 continents.
 

References

• D.J. Kevless: "Into hostile political camps: The reorganization of international science in World War I", Isis 62, 47–60, 1971

• F. Linder: " Wege zur Chirurgie von heute", Langenbecks Archiv 333, 145, 1973

• F. Linder: "Development of Modern Surgery", Surgery, Gynecology & Obstetrics 140, 268, 1975

• B.nc Schröder-Gudehus: "Deutsche Wissenschaft und internationale Zusammenarbeit, 1914–28; ein Beitrag zum Studium kultureller Beziehungen in politischen Krisenzeiten", Geneva, Dumaret & Golay, 1966

• U. Tröhler: "Der Schweizer Chirurg J.F. de Quervain (1868-1940): Wegbereiter neuer internationaler Beziehungen in der Wissenschaft der Zwischenkriegszeit", Aarau, Sauerländer, 1973

• U. Tröhler: "Der Nobelpreisträger Theodor Kocher: Auf dem Weg zur physiologischen Chirurgie", Basel, Boston, Birkhäuser, 1984

• O.H. Wangensteen & S.D. Wangensteen: "Surgical Specialization" in: The Rise of Surgery from Empiric Craft to Scientific Discipline", Minneapolis, University of Minnesota Press, 526–552, 1978