19 December, 2006

Autistic Spectrum Disorder

On Thursday 18th January, Professor Christopher Gillberg addresses the Society on the subject Autism and Asperger's Syndrome.

In the meantime, you can hear the BBC programme on what it is like to be a person with Asperger's, or to live with a child with Autism in the "Am I Normal?" series here ...

04 December, 2006

Pandemic Flu symposium - reflections on the meeting by Dr McIntyre

Session 162
November 23rd 2006

Some 40 members of the Society met in the Ebenezer Duncan Centre with the President, Mr David Ritchie, in the chair. The main business of the evening was a
symposium on Pandemic Flu addressed by Dr Graeme O’May of the Regional Virus Laboratory, Dr Mark Cotton, Respiratory Physician, Dr Helene Irvine of the Public Health Department and Dr Colin Robertson currently working with the Scottish Office on Pandemic Flu planning.

Dr O’May described the mechanisms of genetic change in the flu virus - genetic drift by gradual mutation over time or shift by a reassortment of gene segment between avian and human viruses. These changes could produce increased pathogenicity or transmissibility. If both occurred a pandemic flu could arise. He emphasised that the current H5N1 avian virus was indeed bad news for birds but not for humans. He went onto explain laboratory identification of influenza and how this might respond to pandemic flu. PCR on throat and nose swabs can produce a result in a matter of hours. Laboratory resources would be focused on influenza with working arrangements changed to allow continuous testing. If there seemed a risk of pandemic flu spreading there would be particular attention to viral testing in children where flu tends to appear first. Finally he addressed the difficult issue of vaccination – if vaccines are prepared too early the strain may be wrong, if too late vaccine would be ineffective. The current H5 vaccine is in fact not sufficiently immunogenic to be effective.

Dr Cotton gave an overview of the clinical features of influenza and highlighted some of the differences between epidemic and pandemic flu with the varying virulence of different strains. The 1918 pandemic seemed particularly virulent with the feature found also in other pandemics of a peak of mortality in young adults – 20 times that of epidemic flu. This is likely to be related to primary influenza pneumonia, a disease of rapid onset and progression. The other major distinction from epidemic flu is timing – pandemic could occur at any time of year and seemed to follow a 3 phase pattern over the course of up to a year. However, the severity of the disease could be locally variable. A 1951 epidemic flu outbreak in Liverpool produced a local death rate greater than that of 1918. Dr Cotton emphasised the broad range of non respiratory illness caused by influenza and in particular increased mortality from coronary artery and other vascular disease. There is therefore a inevitable degree of uncertainty of predicting the clinical features of pandemic flu from what we know about epidemic flu and for example recent human cases of H5N1. At one end of the spectrum there is the acute lung injury of influenza pneumonia – at the other end a variety of clinical presentations in the first few days of illness though with a tendency to sudden onset. This led to debate with general practitioners in the audience over the difficulty of initial distinction of influenza from other viral illnesses. Dr Cotton commented that in the context of an influenza outbreak such an illness probably was influenza – in the absence of an outbreak probably not. Assessment of patients at home would usefully use the CURB 65 approach using confusion, high respiratory rate, low blood pressure and aged over 65 as severity markers. In addition availability of pulse oximetry might identify the younger patient progressing to viral pneumonia.

Dr Irvine explained the work in which she had been involved over the previous 6 years in planning for possible scenarios of pandemic flu. This involved a comprehensive structure of groups and committees covering various aspects of medical and social services within the Greater Glasgow area. She was an enthusiastic proponent of planning to improve the effectiveness of response should a pandemic occur. She outlined 3 separate planning scenarios which represented moderate, severe and worst case pandemic events. The moderate corresponded approximately to the 1957 and 1968 pandemics and the severe with 25% of the population affected and 1.5% case fatality ratio was approximately equivalent to 1918. She was dubious about the benefit of planning for the worst case scenario with a 50% incidence and a 2.5% case fatality and perhaps implied that discussions of such scenarios might risk an element of scare mongering. A severe pandemic would mean for Greater Glasgow and Clyde at the peak of infection a weekly toll of 65,000 cases and 970 deaths. The pressure on the Health Service is inevitably increased by an estimate of 2.500 cases and 37 deaths being in Health Service staff leading to a minimum of 12% staff absence. The increased workload applies to both primary care with a doubling of GP consultations and hospital work with a 50% increase in admissions. Discussions of the sort of scenario included comment on differing possible responses from medical staff – those who would find extra work time impossible and others who would rise to the challenge presented by the workload. Dr Irvine also touched on the problem of Tamiflu and the potential difficulties of deciding how a stockpile of antiviral therapy might effectively be used and whether it would in fact make a difference to outcomes.

Finally Dr Robertson addressed broader issues arising from influenza planning. His background is as a Consultant in Emergency Medicine. He had been seconded for a period of some months to work on influenza planning and had been impressed by the extensive work already done in government to look at the implications of a pandemic across various aspects of public life – not just health and social services but maintenance of other services, provision of goods, and law and order. Much of his own work involved raising awareness of the issue particularly in medical groups around the country. There are examples of detailed planning at both international and national level. The global surveillance of influenza viruses is comprehensive and allows the possibility of vaccine development. The response in the Far East with the cull of poultry when H5N1 first arose was impressive. Local responses can be adjusted according to the characteristics of a pandemic outbreak e.g. whether young adults are substantially affected. There was particular planning to deal with young children who are super spreaders of infection presumably because of close contact. Issues of the benefit and drawbacks for example, of school closure arise. Ethical issues which may be posed by pandemic flu are being addressed by a national working party. This already has papers from the WHO addressing ethical challenges for individuals, health service groups and governments. There are inevitably huge uncertainties. In the Health Service these apply to the availability of primary care cover, the capacity of emergency departments, and the availability of High Dependency or Intensive Care facilities. However, there is the possibility of new treatments becoming available, and biological techniques in this area are advancing steadily – the characterisation of the SARS vaccine took 48 days compared to around 8 years for HIV. His final comment was an observation on excellent working relationships within the different health service and government departments involved in this planning.

Mr Ritchie in concluding the evening commented on the range of pessimism and optimism encompassed in this topic and thanked the speakers warmly for contributing to an informative and stimulating evening.

03 December, 2006

Pandemic Influenza - Part 1: The virologist and the physician

Listen to Part 1 of the Pandemic Flu symposium on your mp3 player or computer.

Listen again:
Download [ mp3] 28.2Mb
Listen to [streaming audio]

Further reading:

25 October, 2006

Minutes of Glasgow Southern Medical Society - Presidential Address on 12 October 2006

Minutes of Glasgow Southern Medical Society
Presidential Address on 12th October 2006

Dr David Ritchie, Consultant in Accident & Emergency Medicine presented his Presidential Address to 31 members of the audience. He described the situation in Glasgow around 1870s when there were various hospitals in Glasgow for Specialist Problems but no general hospital in the South Side and for that reason Ebenezer Duncan and other members of the society worked to establish a hospital in the Victoria Infirmary site. At that time there were 250,000 people living in the area around the hospital. In the 1800s 30% of deaths were due to infectious diseases such as tuberculosis and there were 170 infant deaths per 1,000 births.

In 1900 there were 860 patients admitted to the hospital in its first year. The Victoria Infirmary now has 600 beds when the Mansionhouse Unit is included. Now the infant mortality rate is in single figures per 1,000 live births.
In Dr Ritchie's work in Accident & Emergency he has found that he can do all the good things of medicine as described by his first boss:
He can do the best for his patients
He can educate, train and inspire juniors
He can do research.

Emergency care has always been part of medical training for all doctors at some time. In an emergency you do your best. There is a painting in the waiting room in Glasgow Royal Infirmary's Gate House which shows people in period costume waiting around 1910 to be seen. The only change noted is the change in the costume.
Dr Plant in 1970 perfonrmed a pilot study of how to look after a "Casualty Department". He suggested different levels of departments run by Casualty Surgeons, Senior Doctors or even single handed casualty departments. Casualty was always the poor relation.

Departments have increased in numbers over the years. Originally Medical Students learned to suture in the departments and this clearly did not give patients the best deal. Accident & Emergency does not only deal with trauma. GP, Hospitals and Accident & Emergency Departments often share the same patients. Accident & Emergency is also used for training Paramedics, Nurses and Doctors. Trainees still need to be supervised.

In USA the ATLS system was introduced dealing with advanced trauma and life support. This was started following an air crash in Wyoming where a doctor looked after his family who were passengers in crash and were severely injured. He was concerned about the poor quality at the local hospital and he produced the ATLS system which is now run by the American College of Surgeons. This gives structure to dealing with training in life support courses with training and accreditation.

There is no shortage of people wanting to go into Accident & Emergency Medicine. Dr Ritchie attended a career meeting where the Anaesthetic Department managed to attract two people to their stand and Accident & Emergency attracted forty.
Accident & Emergency is also associated with long hard shifts and there is an early learning curve with structured teaching programmes. Shift work appeals at first and "doing things for people".

Imaging has improved dramatically over the years and thrombolysis if necessary has to be given within 30 mintues and this is only possible in A&E. This may be necessary in the future dealing with strokes. The Victoria A&E already has its blood gas analyser, machines for measuring U+E's and lactate.

In the future there may be a large number of Community Casualty Units for what is described as "minor" cases. Clearly the definition of minor is important and quite difficult.

In the Accident & Emergency Dept 80% of patients are seen by Juniors. In General Practice 80% of patients are seen by fully qualified GP's. The future plan would be for 80% of patients in A&E Departments to be seen by trained doctors.

The Victoria Infirmary looks after 250,000 patients the same number as when the
Victoria Infirmary was started. The Victoria Infirmary is about to to be closed.
The meeting was then laid open to questions. The first question was about how many A&E Depts are needed in Glasgow. In reply Dr Ritchie told us that in USA a trauma centre is based in an area where there are 5,000,000 patients. In Scotland the only area good enough to have a trauma centre is Aberdeen which has all specialites including Surgery, Orthopaedics, Intensive Therapy, Anaesthetics and Accident & Emergency all in the one area. He suggested that three A&E Depts would be necessary in Glasgow, although there are clearly going to be two A&E Depts.

Dr Prakash gave an excellent vote of thanks summarising some of the salient parts of the speech.

The meeting was very well appreciated by the members.

Dr William P McKean

23 October, 2006

Presidential Address - Mr David Ritchie

Listen to Mr David Ritchie's Presidential Address on your mp3 player or computer.

Listen again:
Download [ mp3] 40.4Mb
Listen to [streaming audio]

Further reading:


05 October, 2006

Notice of meeting: Presidential Address - 'Casualty to Accident and Emergency'

Thursday 12th October, 2006
"Casualty to Accident and Emergency"
David Ritchie reflects on the raw reality of A&E life and on how on earth he got there. How did ‘Casualty’ develop from a Cinderella extra into ‘Accident and Emergency’ as the central focus of the acute sector?

Mr David Ritchie
Consultant in Accident and Emergency, Victoria Infirmary

Buffet supper 6.15 for 7.00pm
Ebenezer Duncan Centre, Victoria Infirmary, Glasgow

If you are a member of the Society and you would like to book for the pre-meeting buffet, please email 'Buffet' and your name to: Lesley.O'Donnell@gvic.scot.nhs.uk

23 September, 2006


In his 2005 Presidential Address "The First Year of Life", Dr Phil Wilson discussed social development and the importance of attachment. Later in this session of the Society, we will hear Professor Christopher Gillberg describe work on autistic spectrum disorders.

Members of the Society might be interested in hearing a programme that brings these threads together. In Unconditional Love, This American Life host Ira Glass introduces two stories of parental love: the first for an adopted Romanian orphan and the second for an autistic son.

To listen to the programme in streaming audio, follow the link above, then click on the blue loudspeaker symbol.

05 September, 2006

Council Meeting - agenda

Thursday 14th September 2006 at 7.30pm
Conference Room, Floor E, Victoria Infirmary

1. Apologies for absence
2. Minutes of meeting of 27.4.06
3. Matters arising
4. Membership of Council: position of secretary and extra council members
5. Programme detail: Dinner, Other meetings
6. Links with the Royal Medico-Chirurgical Society

30 August, 2006

Council members 2006-7

Honorary President - Dr John Clark
President - Mr David Ritchie
Past President - Dr Philip Wilson
Senior Vice President - Dr Richard Watson
Honorary Treasurer - Dr Liam McKean
Honorary Secretary - Dr Duncan MacIntyre
Editorial Secretary - Dr Jonathan Oates

Syllabus 2006-7: Session 162

Thursday September 14th, 2006 7.30pm (note change of date and time)
Council meeting
Conference Room, Floor E, Victoria Infirmary

Friday September 8th, 2006 from 2pm
Golf Outing - Bonnyton Golf Club

Thursday October 12th, 2006
Presidential Address 'Casualty to Emergency Medicine'
Mr David Ritchie

Thursday October 26th, 2006
Annual dinner
Sherbrooke Castle Hotel, Pollokshields

Thursday November 23rd, 2006
Symposium Pandemic flu – what would it mean for you?

Friday December 1st, 2006
Members of the society are invited to the Annual Christmas Dinner of the Royal Medico-Chirurgical Society – details to follow.

Thursday January 18th, 2007
'Does everyone have an autistic syndrome?'
Professor Christopher Gillberg

Christopher Gillberg, (b. 1950) is Professor of Child and Adolescent Psychiatry at Gothenburg University in Gothenburg, Sweden, and at the medical college of St George's, University of London in Tooting in south London. He has also been a visiting professor at the universities of Bergen, New York, Odense, and San Fransisco
Gillberg is known for his research of autism in children, Asperger syndrome. ADHD and anorexia nervosa. He is the founding editor of the journal European Child & Adolescent Psychiatry, and is the author and editor of many scientific and educational books. He is the recipient of several scientific awards, including the Philips Nordic Prize 2004 for neurological research, and he has more than 300 scientific papers listed in Medline. more...

Thursday February 22nd, 2007
'Glasgow's health priorities – where now?'
Dr Harry Burns

Harry Burns graduated in medicine from the University of Glasgow in 1974. Over the next 15 years he worked as a general surgeon and for the last six years of his surgical career was a consultant surgeon at the Royal Infirmary in Glasgow.
He entered health care management and was, for a time, Medical Director of the Royal Infirmary in Glasgow. Since 1993 he has been Director of Public Health for Greater Glasgow Health Board which is responsible for organising health care and maintaining the health of one million people in the West of Scotland. In 1999 he was awarded a Visiting Professorship in Public Health Medicine, University of Glasgow and is a Senior Research Fellow in the School of Business and Management in the University.
He took up post as Chief Medical Officer for Scotland on 5 September 2005.

Thursday March 8th, 2007
Honorary Presidential Address 'Forensics'
Dr John Clark

Thursday April 26th, 2007
Annual General Meeting
Conference Room, Floor E, Victoria Infirmary

05 August, 2006

Autumn events - advance notice

Friday 8th September - Golf outing
Starts at 2pm at Bonnyton Golf Club. The usual trophies are to be won, but the important thing is to come and enjoy the afternoon. Booked for 16 only. £42 includes the round and high tea afterwards.

Thursday 12th October - Presidential Address
Our President this year is Mr David Ritchie, Consultant in Accident & Emergency.

Thursday 26th October - Annual Dinner
Again at the Sherbrooke Hotel. The recent tradition of musical entertainment to enhance the evening will continue.

07 March, 2006

Notice of meeting: Clinical trials in the 21st Century

Thursday 23rd March, 2006
"Clinical trials in the 21st Century"
Clinical trials are the foundation of evidence-based medicine but trialists, particularly those conducting non-commercial trials, face many challenges today.

Professor Janet Darbyshire
Director, MRC Clinical Trials Unit

Buffet supper 6.15 for 7.00pm
Ebenezer Duncan Centre, Victoria Infirmary, Glasgow

If you are a member of the Society and you would like to book for the pre-meeting buffet, please email 'Buffet' and your name to: Lesley.O'Donnell@gvic.scot.nhs.uk

28 February, 2006

Family Research Matters - audience discussion

Part 2 of Family Research Matters. This recording is of the audience discussion following Prof Graham Watt's lecture given to The Glasgow Southern Medical Society on Thursday 23rd February 2006.

Listen again:
Download [ mp3] 11.2Mb
Listen to [streaming audio]

26 February, 2006

Family Research Matters

Will new developments in genetics render more traditional population studies redundant? How do disease patterns in the West of Scotland differ from those in other developed nations? Why do health behaviour patterns of your parents influence your health later in life? These and other questions are addressed by Prof Graham Watt, Professor of General Practice in his Honorary Presidential Lecture to The Glasgow Southern Medical Society.

Listen again:
Download [ mp3] 32.3Mb
Listen to [streaming audio]

View slides as pdf

Further reading:


10 February, 2006

Notice of meeting: Honorary Presidential Address 'Family matters'

You are cordially invited to attend the meeting:

'Family matters' - the new genetics

Speaker: Prof Graham Watt, University of Glasgow

Date and time: Thursday 23rd February 2006 at 7.00pm

Venue: Ebenezer Duncan Centre, The Victoria Infirmary, Glasgow

This meeting is open to all medical, nursing and paramedical staff.

If you are a member of the Society and you would like to book for the pre-meeting buffet, please email 'Buffet' and your name to: Lesley.O'Donnell@gvic.scot.nhs.uk

Please note that the lecture and subsequent discussion will be recorded for later publication on the Society's website.

09 February, 2006

100 years ago: Session 1905-06; Meeting VIII - The surgical treatment of Senile Hypertrophy of the Prostate

The Society met in the rooms of the Medical Club, 22 Carlton Place on Thursday 25th January 1906 at 9pm.

In the absence of the President, Dr T.K. Monro (Vice-President) took the chair and in all 16 gentlemen were present.

The minutes of the last meeting were read and approved of.

Three letters were read. 1st from the Secretary of the Eastern Medical Society inviting members to be present at their dance on Feb 8th - In reply to this it was stated that the Smoking Concert of this Society fell on the same evening & therefore this invitation could not be accepted.
2nd from Dr Stockman (President) calling an extraordinary meeting of the Society for Thursday Feb 1st to hear a paper by Dr Mason. This was on the requisition of 3 members viz. Dr Richmond, T.K. Monro & R.W. Forrest.
3rd a letter from Mr W.B. Taylor representing Messers Burroughs Welcome & Co promising to give a display of their products on Feb 22nd.

New Members
On the motion of the Chairman the Standing orders were suspended and Dr Farquhar MacRae 256 Bath St was admitted a member.

Death of Dr Duncan McGilvray
The chairman then referred to the death of Dr Duncan McGilvray, a former president of this Society, and said that the Society had sustained a very great loss. He had been for long a prominent member of the Society and his connection with all the social functions of the Society and of the Medical Club were always of a most genial & generous nature. He also reported that at a special joint meeting of the Council of the Society and of the Committee of the Medical Club which was held on the 23rd January a deputation consisting of Dr T.K. Monro (vice president) with the Secretary & Treasurer had been appointed to attend the funeral as representatives of the Society. This was done by the deputation on the 24th January. It was then agreed that the President and Secretary be asked to communicate the sympathy felt by the Society to Dr McGilvray's mother.

Dr J.H. Nicoll's Paper
Dr James H. Nicoll then read a paper on:
"The surgical treatment of Senile Hypertrophy of the Prostate", and showed some instruments, pathological specimens, and lantern slides in illustration of his remarks. The paper was enlivened by a vigorously stated protest against the claims advanced by Mr Freyer of London that he had devised an original operation for enucleation of the prostate. At the Close of the paper Drs T.K. Monro, Richmond, Stewart, Peden, James Russell & J.P. Duncan took part in a short discussion mainly of a complimentary nature on the paper and a few questions were asked. Dr Nicoll then replied very briefly and was awarded hearty applause.

This was all the business.

Precis of Dr Nicoll's paper
He states that:
Senile hypertrophy is an adenoma or adeno-myoma & affects a large proportion of men over fifty, but only in a comparatively small number calls for treatment. The treatment is medicinal, mechanical or operative. Despite all that has recently been said by Freyer & others no new facts have been added to our knowledge of the treatment of senile prostate within the past decade.
But with a mortality of 5% still falling, prostatectomy is gradually relegating the catheter to the role of the truss in hernia, viz. the relief of inoperable cases.
So far as the technique of prostatectomy goes, the operation is an enucleation of the prostate from its capsule by use of the finger. This is the modern operation & is the same operation exactly at the present date as was in the early nineties.
Ralph Stockman.

Archive: Royal College of Physicians and Surgeons of Glasgow
Reference: GB 250 RCPSG 73/1/11 Minute Book No. 6

11 January, 2006

100 years ago: Session 1905-06; Meeting VII - The Treatment of Gonorrhoea and its Complications

The Society met in the rooms of the Medical Club 22 Carlton Place on Thursday 11th January 1906 at 9pm.

The President (Dr Stockman) was in the chair, and in all 15 gentlemen were present.

In the absence of the Secretary, who was ill, the Treasurer Dr R. W. Forrest read the minutes of last meeting & these were approved.

New Members
The Standing orders were suspended & Dr Robert Taylor Beechwood, Dalkeith Avenue, Dumbreck was admitted a member. The name of Dr Farquhar MacRae, 256 Bath St, was proposed for membership by Dr R. T. Halliday & seconded by Dr J. P. Duncan.

Professional Conversation
A professional conversation on the subject: "The treatment of Gonorrhoea and its complications" then took place. Dr James Weir opened the discussion and confined his remarks to Specific Urethritis. Cases got in the early stage with a watery discharge, and treated with injections of solution of 20 grains of silver nitrate to the ounce were frequently aborted.

Dr Achd Young advocated the use of Salol & 10gr doses of Urotropine. Dr Halliday used Urotropine & Methylene Blue. Dr Wauchope after a general statement of his views on the pathology of the disease recommended rest in bed & barley water as a suitable treatment. These views did not seem to be generally acceptable to the members present.

Dr C. E. Robertson gave a clear exposition of the methods of treatment he adopted in his own practice and advocated the use of Hewlets mixture of cubebs & Santal oil. Dr W. K. Peden advocated the use of urotropine and of lavage of the distal 6 inches of the urethra several times a day & cited cases in which it had worked well & said that in later stages 4grs to the ounce of Silver nitrate solution was to be used.

The President then made some remarks & summed up the matter gone over in a general way.

Dr C. E. Robertson on the political question
Dr C. E. Robertson then introduced an informal discussion on the attitude of members of the Society with regard to medical matters in the present political campaign and suggested that questions to be put to the candidates might be formulated. However after some discussion it was pointed out that notice of motion should have been given & the matter dropped.

This was all the business.
T. K. Monro

Archive: Royal College of Physicians and Surgeons of Glasgow
Reference: GB 250 RCPSG 73/1/11 Minute Book No. 6

Further reading
Grains (measure)
Santal oil
UK general election 1906