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Honorary secretary's report
BRITISH THORACIC AND TUBERCULOSIS ASSOCIATION
329
out of the six bacteriologic failures (three non-conversions and three relapses) bacillary resistance to 80 pg./ml. of rifampicin was observed. In these retreatment cases also tolerance was excellent and no untoward effects were observed. The Rifampicins in Fbrulent Bronchitis
K. M. CITRON(London) (with J. R. MAY) Blood and sputum levels of rifampicin were high and apparently adequate after oral administration of the drug. Haemophylus injluenzae and pneumococci were sensitive in vitro. But rifampicin failed in all patients to render purulent sputum mucoid. Moreover, during treatment Haemophilus injluenzae and pneumococci rapidly became resistant to rifampicin. Rifamide given intramuscularly resulted in negligible blood and sputum levels. The sputum of all patients remained purulent. Haemophilus influenzae showed no evidence of becoming resistant during treatment. It is concluded that rifampicin and rifamide are ineffective in the treatment of chronic mucopurulent bronchitis. Respiratory Failure in Myocardial Infarction
PROFESSOR R. M. CHERNIACK(Winnipeg, Canada) Arterial blood gases and pH were assessed in 115 patients who had suffered a myocardial infarction, with and without complicating cardiogenic shock or cardiac standstill. In 11 of the 78 uncomplicated cases and in 16 of the 37 complicated cases the arterial 0, tension was much lower than would be expected on a basis of a three-fold drop in cardiac output, indicating considerable right to left shunting. The death rate in the patients with uncomplicated myocardial infarction was 32 % and that of the complicated cases 65 %. In both cases it was greatest when the arterial pH was low indicating that correction of the acidosis is essential. In many instances administration of one hundred per cent oxygen is inadequate to restore the oxygen tension to normal levels, and controlled ventilation may be necessary to maintain adequate alveolar ventilation. The findings indicate the necessity for repeated assessment of the arterial blood gas tensions and pH in any patient who has suffered a myocardial infarction. If the management of such patients is designed to provide adequate oxygenation, to maintain adequate alveolar ventilation, and to correct the acid base disturbances, the patient may be tided over the stage of ‘cardiac pump failure’.
ANNUAL
GENERAL
MEETING
Honorary Secretary’s Report
There have been three meetings of the Association during the past year. In July, 1968, the Annual Conference was held in the University of Kent at Canterbury with a variety of papers which covered various problems in the field of asthma, antibiotics in respiratory disease, three reports from the Research Committee, and the Presidential address by Dr. F. L. Wollaston, ‘The chest physician yesterday and tomorrow’. The final session was devoted to a panel discussion on medical ethics. The high spot of the social events arranged for ladies was a visit to the archives and library of Canterbury Cathedral. In December a meeting was held at the Royal College of Physicians, the subject being a symposium on drug-induced lung disease. Nine speakers covered the wide aspects of this subject, which was followed by a very well attended informal dinner in the Royal College. About 170 members attended this meeting in addition to about 50 visitors. The spring meeting was arranged jointly with the Netherlands Society of Chest Physicians associated with the Royal Netherlands Tuberculosis Association and took place in the new Netherlands Congress Hall at The Hague. British contributions included a Research Committee report on
330
I-LJRER(‘LE
‘Aspergilloma and open cavities’, and papers on the use of computers, photography in bronchoscopy, deformities of the thorax, and a controlled study of intolerance to ethionamide and prothionamide. The meeting began with a reception by the British Ambassador in his residence and included a concert by the Rotterdam Philharmonic Orchestra and a farewell luncheon given by the Royal Netherlands Tuberculosis Association. It is hoped that within a few years we shall be able to return the hospitality extended to us by our Dutch colleagues by inviting them to a joint meeting with us in England. There will be a meeting of the Association at the Royal College of Physicians on December 5th. 1969, which will take the form of a symposium dealing with occupational lung diseases other than coalminers pneumoconiosis. The Spring Meeting will be in Exeter University with the West Country Chest Society. The membership new members have ordinary members; Dr. Hugh Ramsay,
of the Association is now 855 as compared with 844 12 months ago. Forty-four been elected during the year, of which six were associate members, 38 were eight life members, and four honorary members, namely Professor E. Jancik, Sir Thomas Holmes Sellors and Dr. Peter Edwards were elected.
During the year the Council discussed the possibility of the membership declining as fewer new appointments as chest physicians are made at consultant level. Having regard to the acknowledged wider interest of this Association now shown in the change of name, which became operative on the 1st January, 1969, the Council recommends the appointment for a trial period of 12 months of an Assistant Secretary who shall be particularly responsible for seeking to widen the range of membership of the Association. W. H. TATTERSALL, Hon. Secretary. Research Committee The past twelve months have been particularly active ones for the Research Committee, but before summarizing our research programme I must mention the changes of membership that have taken place. Last October, Professor J. G. Scadding retired as chairman at the completion of his term of office. The Committee would like me to take this opportunity to thank him for his outstanding leadership. We are fortunate that he continues as a member of the Research Committee for a further three years. Drs. P. Heaf and A. R. Somner retired from the Research Committee having completed many years of stalwart service for which we are all indebted. Dr. J. Williams has emigrated and consequently has resigned. Dr. Dewi Davies has been elected chairman, Dr. P. Forgacs vice-chairman and Dr. J. D. Ball deputy honorary secretary. The vacancies on the Research Committee have been filled by the election of Drs. A. Pines, and W. J. H. Leckie, and the nomination by Council of Dr. G. S. Kilpatrick. It is pertinent at this meeting to point out that the Research Committee exists for the express purpose of enquiring into problems posed to it by members of the B.T.T.A. It must be emphasised that it is only by the submission of problems in this way that we can ensure that research is undertaken on the genuine practical problems encountered in the practice of chest medicine. The direction of our future work depends on the active participation of all members in bringing to our notice their problems for discussion by the Committee. The work undertaken during the past year by the respective sub-committees is as follows:ASPERGILLOSISSUB-COMMITTEE:(Chairman: Dr. Dewi Davies; Co-ordinator: Dr. P. J. D. Heaf). The follow-up of patients with residual cavities is continuing. Preliminary analyses of the results were presented at the combined meeting held at the Hague in April of this year. BCG MULTIPLE PUNCTURE SUB-COMMITTEE: (Chairman : Dr. K. Neville Irvine ; Co-ordinator : Dr. Margaret 1. Griffiths). This study has been completed and the report has been accepted by the Research Committee and will be published in Tubercle.
329
out of the six bacteriologic failures (three non-conversions and three relapses) bacillary resistance to 80 pg./ml. of rifampicin was observed. In these retreatment cases also tolerance was excellent and no untoward effects were observed. The Rifampicins in Fbrulent Bronchitis
K. M. CITRON(London) (with J. R. MAY) Blood and sputum levels of rifampicin were high and apparently adequate after oral administration of the drug. Haemophylus injluenzae and pneumococci were sensitive in vitro. But rifampicin failed in all patients to render purulent sputum mucoid. Moreover, during treatment Haemophilus injluenzae and pneumococci rapidly became resistant to rifampicin. Rifamide given intramuscularly resulted in negligible blood and sputum levels. The sputum of all patients remained purulent. Haemophilus influenzae showed no evidence of becoming resistant during treatment. It is concluded that rifampicin and rifamide are ineffective in the treatment of chronic mucopurulent bronchitis. Respiratory Failure in Myocardial Infarction
PROFESSOR R. M. CHERNIACK(Winnipeg, Canada) Arterial blood gases and pH were assessed in 115 patients who had suffered a myocardial infarction, with and without complicating cardiogenic shock or cardiac standstill. In 11 of the 78 uncomplicated cases and in 16 of the 37 complicated cases the arterial 0, tension was much lower than would be expected on a basis of a three-fold drop in cardiac output, indicating considerable right to left shunting. The death rate in the patients with uncomplicated myocardial infarction was 32 % and that of the complicated cases 65 %. In both cases it was greatest when the arterial pH was low indicating that correction of the acidosis is essential. In many instances administration of one hundred per cent oxygen is inadequate to restore the oxygen tension to normal levels, and controlled ventilation may be necessary to maintain adequate alveolar ventilation. The findings indicate the necessity for repeated assessment of the arterial blood gas tensions and pH in any patient who has suffered a myocardial infarction. If the management of such patients is designed to provide adequate oxygenation, to maintain adequate alveolar ventilation, and to correct the acid base disturbances, the patient may be tided over the stage of ‘cardiac pump failure’.
ANNUAL
GENERAL
MEETING
Honorary Secretary’s Report
There have been three meetings of the Association during the past year. In July, 1968, the Annual Conference was held in the University of Kent at Canterbury with a variety of papers which covered various problems in the field of asthma, antibiotics in respiratory disease, three reports from the Research Committee, and the Presidential address by Dr. F. L. Wollaston, ‘The chest physician yesterday and tomorrow’. The final session was devoted to a panel discussion on medical ethics. The high spot of the social events arranged for ladies was a visit to the archives and library of Canterbury Cathedral. In December a meeting was held at the Royal College of Physicians, the subject being a symposium on drug-induced lung disease. Nine speakers covered the wide aspects of this subject, which was followed by a very well attended informal dinner in the Royal College. About 170 members attended this meeting in addition to about 50 visitors. The spring meeting was arranged jointly with the Netherlands Society of Chest Physicians associated with the Royal Netherlands Tuberculosis Association and took place in the new Netherlands Congress Hall at The Hague. British contributions included a Research Committee report on
330
I-LJRER(‘LE
‘Aspergilloma and open cavities’, and papers on the use of computers, photography in bronchoscopy, deformities of the thorax, and a controlled study of intolerance to ethionamide and prothionamide. The meeting began with a reception by the British Ambassador in his residence and included a concert by the Rotterdam Philharmonic Orchestra and a farewell luncheon given by the Royal Netherlands Tuberculosis Association. It is hoped that within a few years we shall be able to return the hospitality extended to us by our Dutch colleagues by inviting them to a joint meeting with us in England. There will be a meeting of the Association at the Royal College of Physicians on December 5th. 1969, which will take the form of a symposium dealing with occupational lung diseases other than coalminers pneumoconiosis. The Spring Meeting will be in Exeter University with the West Country Chest Society. The membership new members have ordinary members; Dr. Hugh Ramsay,
of the Association is now 855 as compared with 844 12 months ago. Forty-four been elected during the year, of which six were associate members, 38 were eight life members, and four honorary members, namely Professor E. Jancik, Sir Thomas Holmes Sellors and Dr. Peter Edwards were elected.
During the year the Council discussed the possibility of the membership declining as fewer new appointments as chest physicians are made at consultant level. Having regard to the acknowledged wider interest of this Association now shown in the change of name, which became operative on the 1st January, 1969, the Council recommends the appointment for a trial period of 12 months of an Assistant Secretary who shall be particularly responsible for seeking to widen the range of membership of the Association. W. H. TATTERSALL, Hon. Secretary. Research Committee The past twelve months have been particularly active ones for the Research Committee, but before summarizing our research programme I must mention the changes of membership that have taken place. Last October, Professor J. G. Scadding retired as chairman at the completion of his term of office. The Committee would like me to take this opportunity to thank him for his outstanding leadership. We are fortunate that he continues as a member of the Research Committee for a further three years. Drs. P. Heaf and A. R. Somner retired from the Research Committee having completed many years of stalwart service for which we are all indebted. Dr. J. Williams has emigrated and consequently has resigned. Dr. Dewi Davies has been elected chairman, Dr. P. Forgacs vice-chairman and Dr. J. D. Ball deputy honorary secretary. The vacancies on the Research Committee have been filled by the election of Drs. A. Pines, and W. J. H. Leckie, and the nomination by Council of Dr. G. S. Kilpatrick. It is pertinent at this meeting to point out that the Research Committee exists for the express purpose of enquiring into problems posed to it by members of the B.T.T.A. It must be emphasised that it is only by the submission of problems in this way that we can ensure that research is undertaken on the genuine practical problems encountered in the practice of chest medicine. The direction of our future work depends on the active participation of all members in bringing to our notice their problems for discussion by the Committee. The work undertaken during the past year by the respective sub-committees is as follows:ASPERGILLOSISSUB-COMMITTEE:(Chairman: Dr. Dewi Davies; Co-ordinator: Dr. P. J. D. Heaf). The follow-up of patients with residual cavities is continuing. Preliminary analyses of the results were presented at the combined meeting held at the Hague in April of this year. BCG MULTIPLE PUNCTURE SUB-COMMITTEE: (Chairman : Dr. K. Neville Irvine ; Co-ordinator : Dr. Margaret 1. Griffiths). This study has been completed and the report has been accepted by the Research Committee and will be published in Tubercle.