The Transactions of the Belfast Medical Society, Belfast Clinical and Pathological Society and the Ulster Medical Society, with Background Notes

Abstract

INTRODUCTION The Ulster Medical Society celebrates two important anniversaries in 2006. The first is the 200th anniversary of the beginning of the Belfast Medical Society; the second is the 150th anniversary of the death of Doctor Andrew George Malcolm (Fig. 1). Malcolm started the Belfast Clinical and Pathological Society in 1853 and it was the amalgamation of that society with the Belfast Medical Society in 1862 which gave rise to the Ulster Medical Society. This paper will look in turn at each of the three societies and their transactions, the latter term taken here to mean any published account of the proceedings. All unreferenced society quotations are from the original minute books. THE BELFAST MEDICAL SOCIETY The first minutes of the Belfast Medical Society are now missing but they were available to Malcolm when he published his medical history of Belfast in 1851.1 He did not give the date in 1806 on which the Society was founded but he did record that the nineteen physicians and surgeons involved had a desire for “mutual improvement in their common profession,” and that “the selection and purchase of books &c., were entrusted to an elected Committee.” Serious differences of opinion among the Hospital attendants led to the Society faltering in 1814 and ceasing to exist in 1818. It was restarted at a meeting in the Fever Hospital on 8 June 1822 “held to consider the propriety of adopting measures for the revival of the medical library…”.2 The original Society had four Presidents from 1806 to 1814 (each presumably serving two years) but until 1850 the revived Society had none, the chair at each meeting being taken by the fifth member to enter the room. This curious shunning of the office of President suggests that the difference of opinion among the more senior members of the original Society may have related to the Presidential succession. It seems clear that both in 1806 and 1822 the main purpose of the Society was to provide a library for the members. This was not a common reason for starting a medical society, only 5 out of 135 senior Scottish medical societies having similar objects.3 By 1859 the library held a total of 1249 titles (including journals and manuscripts). Of these, a substantial number, 538, were from the 18th century or earlier but the Society had been buying new titles and 211 of the collection had publication dates after 1838.4 Six clinical presentations were made to the revived Society from 4 November 1822 to 2 June 1823, the first being two cases of cynanche laryngea, read by Dr J McDonnell and presented by Mr R Coffey. The presentations seem to have been well enough received but for some reason they were not continued – whether this was by agreement or by default is unknown. Dr Malcolm joined the Belfast Medical Society in 1842 and it may be no coincidence that within three years the Society had agreed to receive clinical presentations at its meetings, to publish its proceedings, and to form a pathological museum. On 2 December 1844 it was decided that in addition to the routine business, “communications from members upon Medical and Surgical topics and reports of cases should be received and discussed” and on 3 February 1845 a subcommittee was set up to consider regulations for the conduct of future meetings. The members of the subcommittee included Malcolm and Dr JM Sanders, the proposer of the resolution. It was agreed that library business would come first; that written communications and communications of which notice had been given would take precedence over others; that the members would be permitted to speak once in turn after each presentation; and that the presenter would have the right of reply at the end. The first case under the new rules, one of haematocele, was presented by Dr Sanders on 3 March 1845. The combination of the clinical presentations and discussions at the meetings and the ready access to medical literature provided by the library, meant that the Society offered unprecedented local opportunities for professional education and advancement. The first issue of the Dublin Hospital Gazette appeared on 15 March 1845, just 12 days after Sanders presented his case of haematocele. The Proprietors wished “to afford an accessible channel for the publication of every new fact in Pathology, Diagnosis, and Therapeutics”, and they offered “facilities to the attendants on Provincial Institutions, for publishing those important cases and observations that are continually presenting themselves to their notice.” 5 The coincidence of its appearance and the appropriateness of its objects did not pass the Belfast Medical Society by, and on 5 May 1845 it was agreed that “an abstract of the proceedings of the society be sent regularly to the Editor of the Dublin Hospital Gazette as the proprietors have kindly offered to insert the same.” The first report, the case of haematocele by Sanders, appeared on 1 June 1845 (Fig. 2).6 It was not a strong case and attracted some criticism in the discussion. Reports appeared regularly until 1 April 1846, the last being a description of one of the preparations in the pathological museum. The Dublin Hospital Gazette ceased publication on 1 May 1846, the proprietors explaining that “the time and labour requisite for the continuance of this Journal, is incompatible with their other avocations.” Between June 1848 and May 1849 the Dublin Medical Press published some proceedings. The first report was of a case of diseased spleen by Dr JH Halliday and a number of papers also appeared, most of them dealing with the management of cholera, an epidemic of which had started in Belfast in December 1848. A new series of the Dublin Hospital Gazette began in 1854 and ran to 1862. The ninth volume (1862) has not been available for examination. The earlier volumes only contained brief accounts of the annual meetings for 1856 and 1857 and a rather longer account of the annual dinner for 1858, although some papers which had previously been read before the Society were printed in their own right. The Dublin Journal of Medical & Chemical Science first appeared in 1832. It was then sequentially titled the Dublin Journal of Medical Science, the Dublin Quarterly Journal of Medical Science, the Dublin Journal of Medical Science and currently the Irish Journal of Medical Science. It was sometimes referred to as the Dublin Medical Journal. The Dublin Quarterly Journal of Medical Science ran from 1846 to 1871, and accounts of the proceedings of the Society appeared for the sessions 1857/58, 1858/59 and 1859/60. These proceedings were reprinted as the Transactions of the Belfast Medical Society by the University Press, Dublin. There were two volumes, the first contained the proceedings for 1857/58 and the second contained those for 1858/59 and 1859/60. THE BELFAST CLINICAL AND PATHOLOGICAL SOCIETY It was through Malcolm's efforts that the Belfast Clinical and Pathological Society was formed in 1853. The objects of the Society were “the Cultivation of Practical Pathology, Diagnosis and Therapeutics, by means of the accumulation, and Analysis of appropriate Cases and Pathological Reports, and Public Discussion thereon; the establishment of a Pathological Museum; and the keeping of Records, to indicate the progress of discovery in Medical Science.”7 Analytical and microscopical committees were set up to report on specimens sent in by members, records of each meeting were to be sent to a Dublin journal (or journals) and an annual volume of the transactions was to be printed. During the second session it was decided that lithographed abstracts of each meeting should be offered to non-resident (country) members, the only charge being postage of 1d per week (later standardised at 2/6 per session). The intention was to support the non-resident members who found it more difficult to get to the weekly meetings in Belfast and it seems to have been successful. At the Society's second conversazione held at the close of the third session on the 30th April 1856, Malcolm said “our Society has extended its operations into all parts of the province of Ulster; and its most distant members feel its improving influences almost as vividly as if they were resident, and enabled to join directly in its proceedings. This pleasing result of our weekly lithographed ‘abstract’ is but a slight indication of what I trust may yet be accomplished, in the way of placing the resident and non-resident members more on an equality.” 8 Unfortunately, even today, that equality has still not been reached. A fortnight after the abstracts were offered to the non-resident members, the same privilege was extended to students and the resident (town) members. Malcolm seems to have been prepared to subsidise the production of the abstracts in that he guaranteed that the Society would not suffer financially for that session because of it. In this context it should be noted that he was a very generous donor to the pathological museum and that after his death, his widow had so little money that she had to ask the Society for a contribution in acknowledgement of the money he had expended. The proceedings of the first session are not to be found in the Dublin journals. Those of the second to the eighth sessions appeared in volumes two to eight respectively (1855 to 1861) of the Dublin Hospital Gazette (new series).8 Unusually, during the eighth session the Society was asked where the proceedings should be published. It was agreed on 24 November 1860 to continue to send them to the Dublin Hospital Gazette but the minutes do not record why the question needed to be asked. The Dublin Hospital Gazette was to cease publication in 1862 and perhaps there was some uncertainty about its future even then. During the ninth session the proceedings of the meetings from 26 October 1861 to 18 January 1862 appeared in volumes 33 and 34 of the Dublin Quarterly Journal of Medical Science. On that same 18 January 1862 the Society agreed that “Dr Jacob be informed that arrangements have been made for the publication of the transactions of the present session, but that he be thanked for his attention”. Dr Arthur Jacob was the editor of the Dublin Medical Press 9 and the Society must have been enquiring if the transactions could appear there. They seemed to be certain that they had made arrangements for publishing the session's proceedings in a journal other than the Dublin Medical Press but for meetings after 18 January 1862 that journal was certainly not the Dublin Quarterly Journal of Medical Science. Whether it was the Dublin Hospital Gazette can only be determined when volume nine is examined. The original weekly abstracts of the meetings were handwritten and lithographically printed on a sheet of flimsy paper 10 inches wide and 15½ inches high. The script was dense and difficult to read (fig. 3), and the paper was not suitable for a permanent record. The annual Transactions were better in both respects but their appearance was delayed as they could not be printed until after the close of the session. The accounts of the proceedings published in the Dublin journals were also readable and permanent but would have suffered some delay and would not have been available to most members except through the library of the Belfast Medical Society. The possibility that the lithographed abstracts might replace the Transactions had been considered. Professor JC Ferguson, the president for the second session, said in his closing address at the first conversazione on 5 May 1855, “The ‘Abstract,’ I should hope, however, will not interfere with our volume of Transactions. In fact, I feel that in this matter we have committed ourselves; that the profession expect it from us; and I confidently trust they shall not be in any way disappointed.” 8 His hope and trust might have been realised if the abstracts had remained difficult to read and preserve. Council could see, however, that typeset weekly abstracts would provide members with a readable, permanent and timely record of each meeting – and that they would replace the annual Transactions. It is not possible to say whether the new scheme would have saved money or not. Typesetting would presumably be more expensive than lithography but annual printing costs might be lower and binding costs would disappear. Perhaps Council was most influenced by the immediacy of publication. In any event, at a Special General Meeting held on 24 September 1859, it was agreed “that all Members shall contribute, with their Annual Subscription, the sum hitherto paid for the ordinary Weekly Abstract (2s. 6d), by which the Council will be enabled to issue, during the Session, improved Reports of the Society's proceedings, in a permanent form, which will be forwarded to every Member.” This brought the cost of the annual subscription up to 12/6 for resident members and 7/6 for non-resident members. Those who took the old abstracts would have noticed no change in their annual contribution. The scheme seems to have gone ahead as in November 1859 there was a proposal to enlarge the size of the type and paper (not accepted), and on 21 November 1860 it was agreed that “the first 12 pages of the Transactions be sent out.” Both a will and a way are required if records are to be kept. Council provided the way but the will must have been lacking at the time or since, as no copies of the typeset records exist in the Society's archives. Paradoxically, 23 issues of the flimsier, lithographed abstracts (all for the session 1856/57) have survived although we have lost much else over the years. Copies of the annual Transactions of the Belfast Clinical and Pathological Society for five of the Society's nine years of existence are held in various libraries. It is not known for certain what happened to the Transactions for the other four years but it is likely that for 1856/57 and 1857/58 they were printed but are missing. On 26 May 1859, immediately after Council had agreed to improve the weekly abstracts, Dr H Murney proposed “that in future there be no reprint of the Transactions at the end of the Session.” The minutes do not record if this motion was accepted but if it was it was ignored at least once, as a volume of the Transactions was published at the end of the next session (1859/60). It is unlikely that annual Transactions were published for 1860/61 and 1861/62 but especially so for the latter as that was the last session. When the Transactions of the first session appeared, an anonymous reviewer in the Dublin Medical Press asked how the Belfast society, with only 96 members and half the subscription of the Dublin Pathological Society, could publish its proceedings when the Dublin society, the senior pathological society in the British Isles, could not.10 The answer undoubtedly lay in the character and activity of Dr Malcolm and of those with him in the venture. Council spent some time deciding on the format of the Transactions. Initially they planned spending £5 on so many copies of a small octavo volume and asked for estimates of the number of pages they would get. Alexander Mayne offered the best value (200 copies each of 48 pages) and his estimate was accepted. However, all this careful planning came to naught when it was calculated that after “inserting laws, list of members, specimens, cases etc.”, only 20 pages would remain and that these would not accommodate the debates. Council then resolved that “the Transactions be printed in full, including the Debates; and that the added expense be met by such means as the Council may thereafter consider expedient.” This was magnificent of Council but there is perhaps a suspicion that Malcolm offered to subsidise the costs in the way that he had done for the lithographed abstracts and for the museum. The first Transactions contained 132 numbered pages and 11 pages of illustrations. Mr Mayne's final account was considered “very moderate and reasonable” and was paid but the actual sum was not revealed in the minutes. In the first year the cost of printing “Laws, Circulars, Case-papers, Tickets, &c.” was £14 17s 2d, while in the second the cost of printing “Transactions, Reports, Circulars, &c, Binding, and Advertising” was £26 16s 8d. Binding was priced separately from the printing and cost £2 2s so perhaps the first Transactions cost £10 – double that which Council had originally planned. The binding included a stamped cover and the cheap appearance of this drew some mild criticism from the reviewer. However, the cheapness of the cover goes some way to answering his question as to how the Society managed it. Every member received a copy free. The original intention was to charge new members 2/6 per copy but the price was raised to 3/- to meet the increased costs. Spare copies were later offered to medically qualified non-members at the same price. The sale of the first Transactions brought in £1 16s. THE ULSTER MEDICAL SOCIETY Malcolm died on 19 September 1856 of congestive heart failure secondary to rheumatic mitral and aortic valve disease. He had been under the care of Dr JM Neligan of Dublin for about two months before his death and he must have known of the seriousness of his condition when he rose to reply to the toast, “The Belfast Clinical and Pathological Society, and its founder, Dr Malcolm”, proposed by Dr McGee at the 33rd Annual Dinner of the Belfast Medical Society on 10 June 1856. Consequently it is likely that his words were chosen to reassure those who might in the future have to decide the fate of the Clinical and Pathological Society. His speech was not recorded in full but he was said to have “expressed a hope that the time was not very distant when the parent ‘Medical Society’ and the ‘Clinical’ would be united into one great Society for the medical men of Belfast and the entire province.”11 That union came about six years later, and we continue to benefit today from his foresight and genius. By the early 1860s both societies were showing signs of faltering. The Belfast Medical Society Council Report for the 1860/61 session, read at the annual meeting on 6 June 1861, “expressed the regret of the Council that the affairs of the Society are not in a more flourishing condition, inasmuch as but one new member had joined during the past year, whilst one had died, another retired, and three others would become free members during the ensuing year.” The Belfast Clinical and Pathological Society Council minutes had become neglected with no dated records for the session 1861/62 being entered in the minute book at all. Meantime, the proceedings of the Medical Society were approximating those of the Clinical and Pathological Society. It is true that the former still had the medical library and that the latter still had the pathological museum and the analytical and microscopical committees, but both were now presenting cases at their meetings and both were publishing their proceedings (the Medical Society intermittently). With similar problems, largely similar activities, and a limited pool of potential members, it made sense to consider amalgamation. Dr Murney seems to have been responsible for most of the planning, and all came to fruition on 30 April 1862 with the formation of the Ulster Medical Society. In 1859 there were 55 names on the list of members of the Medical Society and 99 on the list of the Clinical and Pathological Society. Thirty-one names appeared on both. Assuming that the numbers in 1862 were similar, the newly formed Ulster Medical Society might have started with about 120 members. It might be expected that the new Society would attract more members and 11 applications for membership were indeed put forward to the first meeting. The initial level of the annual subscription is unknown but a few years later, in an effort to encourage new members, it was suggested that the subscription for town members be reduced to one guinea. While this was significantly more than the subscription for the Clinical and Pathological Society, it was actually less than the subscription to the Medical Society in 1822. The combination of the greater number of members and the higher subscription meant that the Ulster Medical Society was in a stronger financial position than either of its predecessors. On 8 November 1862, Council was asked to consider the question of the publication of the transactions and on 15 November the Society resolved “that the transactions of the Society be offered in future to the Dublin Medical Press for fortnightly publication.” Dr Browne was asked to communicate with the Editor and a week later read a reply from Dr Jacob who must have agreed to accept the Society's offer as Dr JC Ferguson's presidential address appeared in that journal on 26 November 1862. Case reports appeared the following week (3 December) and again on 17 December and 31 December. There were a total of nine published presentations in that first month but only once were the discussions included. The significance of this is only apparent when it is known that there was disagreement within the Society on the subject. At a special meeting called for 27 December 1862, the members divided equally between those who thought that the discussion following each presentation should be published and those who thought that it should not. The President was forced to use his casting vote on two occasions and eventually it was agreed “That a Committee of Publication be appointed consisting either of the Council or a portion of the Council for the purpose of [reviewing] discussions held on papers or communications made to the Society, before issuing them to the profession in any form.” Nothing further appears in the minutes on this topic but discussions, perhaps edited, were published from then on although those for the first case published in January 1863 only appeared the week after. Never again would the Society have so many presentations published in the Dublin Medical Press in so short a time. Indeed only six appeared during the whole of 1863 although the annual meeting, the presidential address and a dinner given for the medical officers of the Channel Fleet were all reported. The next year, 1864, was worse with only one appearing but Dr Whitaker's comments to the Society on the new edition of the British Pharmacopoeia extended over 11 pages and there was a paper from Dr Keown on Ship-Malaria. Publication in the Dublin Medical Press then ceased but in 1868 the proceedings started to appear in the Dublin Quarterly Journal of Medical Science and selected reports continued to be printed there until 1894. The last clinical presentation appeared in volume 90 (1890) and was a report by Mr H O'Neill of two successful cases of nerve suture and tendon suture following lacerations of the forearm, while the last paper was Brigade-Surgeon FE M'Farland's presidential address which appeared in volume 98 (1894). The Lancet published some proceedings of the Society but very intermittently as the Ulster Medical Society was competing with many other societies for space in the journal. Professor J Cuming's presidential address for the 1868/69 session appeared on 7 November 1868 and the first case reports, albeit very brief being part of the annual report of Council, appeared on 16 November 1872. The last paper was a summary of a lecture to the Society by Drs SB Boyd Campbell and TH Crozier on 1153 cases of cardiovascular disease, and this appeared on 2 December 1933. On 7 February 1863 the minutes record that “A letter from the Editor of the ‘Dublin Medical Press’ was read relative to the reprinting of the Transactions of the Society and offering to throw off a hundred copies … at the rate of a guinea per sheet. The Secretary was instructed to write the Editor and inform him that the Society would accept his terms.” Despite this early decision, the first Transactions of the Ulster Medical Society did not appear until 1865 although they did include selected proceedings from the three sessions 1862/63, 1863/64 and 1864/65. They were printed by Thomas Deey in Dublin at the office of The Medical Press. Our knowledge of the Transactions for the next 20 years is incomplete. Copies exist for three sessions (1872/73, 1877/78 and 1880/81) and the Society minutes record the printing of two sessions (1873/74 and 1876/87). The Council minutes, which should contain fuller details, are missing. The volume for 1872/73 is smaller than the others and was printed by Alexander Mayne in Belfast. Up until 1889/90 all other extant volumes were printed in Dublin while after that they were printed in Belfast. The Transactions appeared continuously from 1884/85 to 1898/99, the last four of these volumes (from 1895/96 to 1898/99) being shared with the North of Ireland Branch of the British Medical Association. Their proceedings appeared after those of the Society and took up, on average, a third of the total pages. At a Council meeting on 29 June 1900 a letter from the Branch was read stating “that the Branch would not any longer pay their half of the cost of printing the transactions but would pay pro rata.” After some discussion, Council decided that “the transactions of the Ulster Medical Society be not printed this year [1899/1900].” When the Transactions for 1900/01 appeared they contained only the Society's proceedings. Publication then continued up to 1928/29 although sometimes two or three sessions were printed in the one volume. The last paper was by Dr Foster Coates on the pituitary gland (fig 4). On 22 January 1931, Professor AM Drennan raised in Council the question of the formation of a local medical journal. This suggestion was sent to a subcommittee who approved of the idea and reported back to Council on 30 April 1931 with a list of recommendations. One of these was that “the transactions of the Ulster Medical Society comprising papers read during the last two years be not published.” The report was accepted by Council and by the Annual General Meeting on 20 May 1931 and so the Transactions came to an end, supplanted by the Ulster Medical Journal. One curious exchange occurred after the first issues of the Journal had been sent to the Keeper of Printed Books at the Copyright Receipt Office in the British Museum. Apparently realising for the first time that the Ulster Medical Society had been publishing the Transactions for many years, the Keeper wrote to the Editor of the Journal, Dr R Hunter, demanding a copy of every issue. Dr Hunter replied pointing out that he was not responsible for the Transactions and that furthermore in his view they were exempt, as they had been printed for private circulation and not offered for sale. DISCUSSION There was never an editor of the transactions as such and the honorary secretaries seem to have been responsible for arranging the material for publication. It was customary to record each case in the ordinary minutes of the meetings although sometimes the notes were very brief. In the early years the proceedings and discussions would have been transcribed from the honorary secretary's notes but the more formal papers later on must have been prepared by the authors. Dr R Esler published two papers on the early history of medicine in Belfast in the Transactions of the Ulster Medical Society for 1885 and 188612,13 (and other histories of the three societies and their members have appeared in the Ulster Medical Journal 14–16 since then). The number and the quality of illustrations rose with time. The Clinical and Pathological Society had used sketches and Daguerreotypes to illustrate cases at meetings, and a number of lithographs appeared in the first and second annual Transactions of that society. The first photographs, a pair, were published in 1892 in the Transactions of the Ulster Medical Society. These were of a child, Annie B, before and after an operation for a facial naevus. The first X-ray, that of a hand in a case of acromegaly, appeared in 1909 and the first ECG in 1914. Great advances in medicine were made over the 84 years of the transactions and, of course, even more advances have been made in the 77 years since they stopped. In the early days cupping and bleeding were still being recommended, some patients being bled until they fainted, and drugs were prescribed with faith if not science. For instance, on January 26, 1856, during a debate on the best local treatment for severe scarlatinal sore-throat, it was reported that “Professor Ferguson varied his local treatment in each case, and thought that we should rely chiefly on the constitutional treatment of the disease. Professor Stewart, Dr Patterson, and Mr Browne confirmed the value of the strong solution of nitrate of silver, as recommended by the President. Dr Moore preferred a dilute solution of nitric acid; Dr Lynch used a syrup made with lemon juice and sugar; Dr Young preferred a linctus of muriatic acid and honey; Dr Pirrie had successfully used the tincture of iodine, but he had not much faith in local applications.” 8 On reading these early proceedings, it is difficult at first to understand how the clinicians could have believed that what they were doing was right but in some respects we may be no better. Those celebrating the 300th anniversary in 2106 may have equal difficulty in understanding how we could have applied the results of clinical trials on populations to individuals who would not be likely to benefit from the recommended treatment. Our predecessors were as clever, educated, energetic and resourceful as ourselves (perhaps more so) but they were constrained by their environment just as we are by ours. What we can do is to share with our colleagues in the past and in the future the same desire for excellence in the art of medicine and the same desire to seek the truth – quaerere verum.