doi:10.1093/brain/awv062
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DORSAL COLUMN
Book Review
The achievements of the World Federation of
Neurology
The World Federation of Neurology (WFN) is now the
major international association for clinical neurologists.
But in his overview of the organization’s first 50 years,
Johan Aarli (Fig. 1) makes it clear that to establish itself
in this position the World Federation overcame many difficulties and complex adverse circumstances through the efforts of a succession of individuals with the necessary
commitment and powers of persuasion.
The specialty of clinical neurology developed in the latter
half of the 19th century. By the 20th century, there was a
perceived need for international collaboration to promote
further developments in this field of study and a need for
the dissemination of information and education of doctors
seeking training in neurology. These needs had to be satisfied against a background of two World Wars, political
ferment and complex financial crises.
But, on the positive side, the WFN has benefited from
generations of distinguished and committed neurologists. It
has also benefited from advances in communication
through the internet, air travel and telephone conferencing.
Thus, it must be remembered that in 1930, a meeting of
fellow neurologists had to be set up by surface mail, travel
was by ship and face-to-face discussions took place at a
pre-arranged meeting venue. Now the process that we
take for granted is almost instantaneous.
The WFN was established to create an academic forum
for research, training and the exchange of friendship and
ideas. In 1957, in Brussels, as the culmination of preliminary talks between three individuals, the first seed of the
WFN was planted and its first constitution and by-laws
were written. These individuals were Houston Merritt
(USA), Ludo van Bogaert (Belgium) and Pearce Bailey
(USA). They overcame doubters:
Sir Francis Walshe ‘Neurology is at a cross-roads . . .’
Sir Geoffrey Jefferson ‘Where else has it ever been? . . .’
Importantly, Merritt and Bailey obtained a generous
grant of annual funds for 5 years from the US National
THE HISTORY OF THE
WORLD FEDERATION OF
NEUROLOGY: THE FIRST 50
YEARS
By Johan A. Aarli 2014.
Oxford: Oxford University
Press
Price: £39.99
ISBN: 978-0-19-871306-7
Institutes of Health. The resolution to charge for annual
membership at $2 per member had limited success, and
over the next 5 years the financial situation became critical.
It was saved by the work of two members who were elected
in 1965 by the Council of Delegates of the WFN in Vienna.
They were Macdonald Critchley, President; and Henry
Miller, Secretary-Treasurer General. For the WFN, the
Critchley/Miller era (1965–73) was critical because the
American funding had run out and the Federation was
sliding towards bankruptcy.
It would be hard to imagine a more improbable duo to save
the WFN in crisis than Macdonald Critchley and Henry
Miller. If Macdonald Critchley was a highly intelligent Don
Quixote then Henry Miller was an equally articulate but provocative Sancho Panza. But between them, and with the support of John Walton, they persuaded the Federation delegates
that, without a research arm, the WFN would be impotent,
and that a WFN Research Committee should be formed in
place of its semi-independent predecessor, and finally that its
Chairman should have a seat on the WFN Executive
Committee. The Research Committee was born in a spirit
of antagonism but quickly grew into a creature of compromise, and matured into an essential strength of the Federation.
Received February 2, 2015. Accepted February 2, 2015
ß The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved.
For Permissions, please email: [email protected]
Book Review
Figure 1 Johan A. Aarli.
One of the delights of this book is the pen-portraits of the
various protagonists in the history of the WFN. Aarli seems
to remember many of those named above, and is able to give
vivid personal descriptions of their strengths and weaknesses.
He also includes a brief background of what was taking
place in the world, so that the reader is able to understand
how the WFN was affected by world events. Thus, during
Macdonald Critchley’s presidency he mentions Soviet troops
invading Czechoslovakia, the Vietnam War, Armstrong
landing on the moon, and China becoming a member of
the United Nations. He also reminds us that neuroimaging
with CT began in 1971 and that the Nobel Prize for
Physiology or Medicine in 1967 was awarded to Granit,
Hartline and Wald for their work on the physiology and
neurochemistry of vision.
John Walton succeeded to the Presidency in 1989 and
Aarli describes his 8 years in the Presidency as the
‘coming of age’ of the WFN. During his time, Walton
made the WFN a UK company limited by guarantee and
a registered charity under UK law with the considerable tax
benefits that ensued. And he revised the committee structure and gave the committees defined responsibilities. In
1985, at a World Congress in Hamburg, it had been
agreed that a proportion (later set at 50%) of the profits
of the Congresses should be given to the WFN. From 1989,
every four-yearly Congress turned in significant profits,
allowing the WFN to maintain a capital financial base on
which it became able to support a variety of projects and
initiatives. The WFN charged dues from each member society, and these—together with royalties earned from its
scientific journals—gave an annual income sufficient to establish and maintain a permanent Secretariat in London.
Since 1997 (Buenos Aires World Congress), the WFN
had consolidated its position as the organization to improve neurological health worldwide by the prevention
and treatment of disorders of the nervous system, and to
promote research and educational standards in neurology.
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This task was achieved by a succession of distinguished
and committed neurologists worldwide, supported by
Trustees and a Council of Delegates from every country
affiliated to the Federation (117 in 2014). It has also
been achieved by establishing some 40 research groups
(many publishing their own journal) affiliated to the
WFN Research Committee and organizing their own meetings as well as advising the organization at World
Congresses of speakers and topics. It is true to say that
the enormous success of World Congresses has been primarily attributable to the work of the Research Committees
and their Chairmen.
As its name implies, the WFN is a federation of national,
regional, and continental groupings of neurologists.
Through these diverse groupings, the WFN represents neurologists worldwide at the World Health Organisation
(WHO) and membership dues of $3 per member per
annum have remained unchanged for many years.
The need for a global health organization was first recognized after World War II and the WHO was established in
1948, on 7th April—World Health Day. The focus by the
WHO on ‘health’, as opposed to taking ‘illness and diseases’ as the focus for public health activities, led to the
need for negotiation by the WFN. Thus the WHO placed
neurology within its organization as a part of ‘mental
health’ or psychiatry. To neurologists ‘brain health’ was a
more acceptable term to use when referring to neurological
diseases. But this semantic argument was finally accepted
by the WHO only after Aarli had achieved two reforms.
The first reform was to align the geographical groupings
of countries in the WFN to approximately the same format
as the WHO. This led to a ‘neurological atlas’, establishing
resources for neurology across the world, and defining
inequities and needs across regional and income groups in
different countries.
The second related to the International Classification of
Diseases (ICD) drawn up by the WHO. This classification
clearly made a distinction between mental illness and physical–neurological diseases. The WHO recruited the WFN to
revise ICD for neurology. This task was started by Aarli
and is aimed to be complete in 2015 under the chairmanship of the current President of the WFN, Dr Raad Shakir.
Thus after a somewhat lengthy and laborious process of
discussions, negotiation and hard work, neurology is at last
accepted as distinct from mental health, having different
epidemiological and educational needs.
The WFN also contributes to the education of neurologists in training and to research, especially epidemiological
research. And it assists with the arrangements for meetings
and programmes in each region. Aarli has been particularly
active in creating ‘The Africa Initiative’, which aims to establish training programmes, support new national neurological associations, develop travelling fellowships and
support public health activities in Africa. These activities
are outlined in this book.
This ferment of activity in the WFN has not been
without its problems. Two senior officers have suffered
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imprisonment, and one Vice President-elect was accused
(wrongly) of financial improprieties (the Chief Prosecutor
resigned as soon as he was compelled to admit error). A
chapter is devoted to personal accounts by two of the individuals involved.
The WFN is generally known to practising clinical neurologists for the World Congresses of Neurology (WCN) that
it organizes with, and in, countries throughout the world.
These Congresses are popular, with delegate numbers now
exceeding 7000 and each Congress lasting 8 days. They are
expensive, but the support of commercial interests mitigates
the expense for some, and the WFN contributes bursaries for
many hundreds of delegates from developing countries. But
the WCN are popular chiefly as a result of the quality of the
programme. Invited keynote speakers (often including a
Nobel Prize winner) will introduce major topics in neurological practice and are followed by invited experts with
different special interests who present their views and research. Free communications of research from young neurologists are chosen by the Research Committee. But the
meetings consist of more than a diet of academic presentations. Introduced in 2001 at the London WCN,
‘Neurological Tournaments’ have proved very popular.
Teams from different countries compete daily in a knockout quiz of obscure neurological knowledge. The host country draws up the questions and chairs the tournament with
the Final Round on the last day of the Congress.
The Congresses have been consistently and increasingly
successful but there is always the risk that a large international meeting, which these Congresses have become, may
be affected adversely by world events or even targeted for
political reasons. For the WFN there have been several
‘near misses’.
Book Review
For example, the organizing committee for the 2001
Congress in London had to find a venue suitable for a conference likely to attract many thousands of delegates. It had
been a tradition that the Congress was held in September,
but when the proprietors of the venue ‘Earls Court’ reported
no availability in September 2001, the decision was made to
move the date of the Congress to June. This proved to be a
fortunate choice as delegates otherwise would have been
travelling around the time of the 9/11 atrocity in New
York. Similarly, in 1997 the Congress in Argentina
(Buenos Aires) was a considerable financial success for the
WFN. But this would have turned to complete failure if the
collapse of the Argentine currency in 1998 had happened 6
months earlier. Even in Sydney in 2005, on the first day of
the Congress the police announced that they had just averted
a bomb plot in the city. Congress organization has been
lucky to avoid disasters that could have damaged it fatally.
The WFN has therefore not only survived but evolved,
flourished and succeeded over the 50 years of its history.
Aarli’s comprehensive account of the history and the structure of the WFN is in a nicely presented volume. His personal experience of the Presidency and knowledge of most
of the personalities in the story give it authenticity and
there is an informative preface by Lord Walton, who has
played a major role in the development of the Federation. It
will be read with interest by neurologists who want to learn
more about this important organization and by those who
have a connection with the WFN.
Richard Godwin-Austen
Nottingham, UK
E-mail: [email protected]
Advance Access publication March 24, 2015