ICS History
The Irish Cardiac Society 1949-1999
Some Highlights of the Half Century | By Dr GF Gearty (Dublin, Ireland).
Introduction | The Forties | The Fifties | The Sixties
The Seventies | The Eighties | The Nineties | Today
Cardiologists have been around much longer than a mere half century. Indeed an historical note about Irish cardiology would be incomplete without some reference to our illustrious forbearers John Cheyne (1777-1836), Robert Adams (1791-1875), Dominic Corrigan (1802-1880) and William Stokes (1804-1877) who have left enduring marks now eponymously enshrined in medical literature. In addition, William Stokes' textbook “Diseases of the Heart and Aorta” (published in 1854) was a quite remarkable contribution to the literature of the day.
Nevertheless until around the mid century (1949), the common cardiac problems were within the comfortable competence of the general physician while the specialist studied wave forms unravelled the mysteries of electrophysiology and juggled with the four heart sounds. Heart failure was treated with digitalis and mersalyl, heart attack was managed with morphia and bed rest for up to six weeks, while malignant hypertension was invariably fatal. There were no coronary care units or diagnostic laboratories. The cardiac department was the room that housed the ECG machines.
However, things were stirring and the 40s were exciting times. The surgeons were addressing congenital defects with ligation of the patent ductus, resection of aortic coarctation and were dramatically transforming the blue baby by the Blalock-Taussig anastomosis. In addition, the then common problem of mitral stenosis was beginning to yield to surgical assault. There was an urgent need for more precision in diagnosis, accurate haemodynamic data and particularly reliable angiographic pictures to guide the way.
At this time Dublin boasted 12 teaching hospitals associated with our three medical hospitals, all offering a comprehensive medical and surgical service, all staffed by general physicians, but each with at least one individual with a special interest in cardiovascular medicine. Some were members of British and European cardiac societies and occasional visitors to US centres. All were familiar with the literature of the day and thus keenly aware of the challenging new developments. At this exciting time the Irish Cardiac Society was conceived and born.
The Forties
At this time Dublin boasted 12 teaching hospitals associated with our three medical hospitals, all offering a comprehensive medical and surgical service, all staffed by general physicians, but each with at least one individual with a special interest in cardiovascular medicine. Some were members of British and European cardiac societies and occasional visitors to US centres. All were familiar with the literature of the day and thus keenly aware of the challenging new developments. At this exciting time the Irish Cardiac Society was conceived and born.An overview of subsequent decades chronicles specialist developments and reminds us of all that has been achieved and particularly pays gentle homage to those whose foresight and enthusiasm ensured that specialist developments in Ireland kept pace with modern medicine and best hospital practice.
May 31st, 1949
An informal meeting by invitation was convened by Dr P.T. O'Farrell to discuss the formation of a cardiac society. Those present were: Prof. L. Abrahamson (Richmond H.), Drs B.G. Alton (Mater Hospital), O. Fitzgerald (St Vincent's), L.K. O'Malley (Mater), B. Mayne (Meath Hospital), R.E. Steen (National Children's Hospital), and P.T. O'Farrell (St Vincent's).
Letters of support with an apology for their absence was received from Prof. H. Moore, Dr R.T. Jackson and Dr J. Lewis. There was enthusiastic support for the project as established and it was decided to invite the following as founder members: Prof. V.M. Synge (TCD), J.M. O'Donovan (UCC), M.J. O'Donnell (UCG) and Drs J.A. Wallace (SPDuns), TM Kavanagh (Temple Street Hospital), and also Drs Boyd Campbell, Marshall and V. Breakey (Belfast).
November 3rd, 1949
The inaugural meeting of the Irish Cardiac Society was held at St Vincent's Hospital. The Society was formally established with agreed objectives, constitution and rules. P.T. O'Farrell was elected first chairman, B. Mayne secretary/treasurer with committee members L.K. Malley and J. Lewis. At this point membership was limited to 20 members, and a facility to invite visitors to the Society was envisaged. Four annual meetings were planned and a subscription was fixed at one guinea. A specialist library was established and postgraduate training courses in cardiology were also considered.
The Fifties
In the early years, indeed for the first couple of decades, there were four meetings annually including an annual general meeting. The meetings were held in the evening at about 8.30pm in the various hospitals, usually in the boardroom followed by a light supper. The average attendance was about 12 members with three or four visitors. The programme generally had a strong clinical bias with occasional special topics and always an energetic discussion involving most members present. Unfortunately, the minutes do not record the frank lively discussions which, in my recollection, were often the most exciting part of the meeting.
1950-55
Early presentations included 'Steroid Therapy for Rheumatic Carditis' (Moore), 'Phaeochromocytoma' (Alton) and 'Tuberculosis Pericarditis' (O'Donnell). Electrocardiography figured prominently with reports from Mayne and Malley about oesophageal electrodes and Goldberger leads.
November 8th, 1950
T.B. Counihan, R. Mulcahy and S. O'Toole were elected to the Irish Cardiac Society, a significant event in that they were the first members to have worked and trained in London in specialist cardiology, and thus introduced modern technology to our cardiac services.
March 9th, 1955
Surgeons had been admitted to the Society in 1953 and indeed T.C.J. O'Connell (St Vincent's Hospital) had previously described his experiences with mitral valvotomy on June 29th, 1950. Now he reported successful ligation of the patent ductus arteriosis in 68 patients with one fatality and two late re-canalisations, and seven cases of closed mitral valvotomy during pregnancy. His series also included six cases of aortic coarctation.
Maurice Hickey reported 40 PDA ligations while E. O'Malley reported seven cases of aortic coartations. November 19th, 1958 Indirect atrial septal defect closure was now established with a series of case reports from Counihan & O'Malley (9 cases) and O'Toole & Hickey (29 cases).
Guest lectures by invitation had become an annual event in the late 50s. and were usually widely advertised and held in the Royal College of Physicians in association with the Academy of Medicine. They were popular and well attended events, indeed often the highlight of the year. Aubrey Leatham ('54) discussed heart sounds and phonocardiography, while Walter Somerville ('56) outlined problems in the diagnosis and management of coronary heart disease, W.M. Whitaker ('58) discussed coronary pulmonale and John McMichael
('59) discussed hypertension.
Steen presented a gold medallion with a ling drawing of William Stokes, our presidential badge. Towards the end of the decade, the Society produced a comprehensive review of cardiac services which estimated future requirements in the form of a detailed memorandum to the Department of Health.
The Sixties
March 1st, 1961
The Framingham message was beginning to make an impact. M.P. Flynn reported on the smoking habits of school children in the Midlands ? 1389 boys and 1317 girls. The survey revealed that 20-30% of urban boys and 4-7% of urban Mulcahy (St Vincent's Hospital) produced data showing a significant association between smoking habits and coronary artery disease.
1960-65
There was considerable interest in congenital septal defects with guest lectures from Ronald Gibson (London), Heim de Balsac (Paris) and Colin Ferguson (Manitoba). Reporting on a series of 200 cases of open heart surgery, Ferguson outlined the problems and difficulties. Ward and O'Donnell, reporting from the American Academy of Paediatrics, again stressed the difficulties, the relatively poor early surgical results and particularly the need to centralise the experience since only large throughputs offered acceptable results.
March 5th, 1965
The inaugural meeting of the Irish Heart Foundation, the formation of which was instigated by ICS members, was a considerable success. Guest speaker Paul Dudley White reviewed his long life in cardiology, particularly the rarity of coronary artery disease and heart attack during his student days in Boston.
March 2nd, 1966
O.C. Ward (without Romano) presented his observations on Stokes Adams episodes provoked by exercise and emotion in children with prolonged QT syndrome. Ten familial cases had been found in 25 studies.
November 2nd, 1966
A very comprehensive review of rehabilitation services was provided by T.Gregg indicating clearly the relevance of this aspect of cardiac care, so far rather neglected.
October 20th, 1967
Intensive coronary care arrived with a fanfare from Edinburgh, a very comprehensive overview was provided by Michael Oliver and Desmond Julian, who were, at that time, directors of ICU at the Edinburgh Royal Infirmary. There was a packed house at an open meeting in St Vincent's Stephen's Green.
March 6th, 1968
Coronary care results from Belfast City and St Vincent's were presented, the former reporting 140 acute infarcts over an 11 month period with 21.4% mortality, the latter reporting 117 acute ischaemic events over a 12 month period with 16% mortality.
March 5th, 1969
Interventional cardiologists were beginning to make a mark with Ward reporting Rashkind Septostomy for transposition of the great vessels. Shaw and Hogan reported their experiences with open heart surgery, bypass and profound hypothermia at Baggot Street, reporting a series of 28 cases including six patients with Fallot's Tetralogy.
The Seventies
November 4th, 1970
N. Hickey reported a three-year experience with the experimental mobile coronary care unit utilising specially trained paramedics organised by the coronary care committee of the Irish Heart Foundation; 1978 calls had been received, 66% eventually were proven heart attacks, 20 episodes of ventricular fibrillation were witnessed, 17 successful defibrillations took place with 11 ultimate hospital discharges. The IHF had also sponsored an on-call rota for the cardiac units of the city and provided specialist training for CCU nurses throughout the country.
April 10th, 1974
Neligan presented the first report from the National Open Heart Unit which had been established by E. O'Malley and K. Shaw in November 1971. To date there had been 277 open heart procedures, 85 mitral valve replacements (two deaths), 61 aortic valve replacements (one death), 36 aortic and mitral valve (with eight deaths), 13 mitral and tricuspid valves (three deaths), eight aortic, mitral and tricuspid valves (four deaths). The total included 66 congenital defects with seven deaths, four Fallot's Tetralogy.
March 8th, 1972
The importance of risk factor screening had begun to be appreciated and Gearty reported data in relation to 10,000 examinations.
April 10th, 1974
Neligan presented the first report from the National Open Heart Unit which had been established by E. O'Malley and K. Shaw in November, 1971. To date there had been 277 open heart procedures, 85 mitral valve replacements (two deaths), 61 aortic valve replacements (one death), 36 aortic and mitral valves (eight deaths), 13 mitral and tricuspid valves (three deaths), eight aortic, mitral and tricuspid valves (four deaths). The total included 66 congenital defects with seven deaths, four Fallot's Tetralogy.
December 19th, 1973
Advancing medical technology now made an increasing impact with extensive reviews of echocardiography (J.H. Horgan) and coronary angioplasty (G.F. Gearty).
November 18th, 1977
The William Stokes Lecture was established. Initially it was envisaged that the Society would invite young Irish graduates training in cardiology abroad to present their work to the Society.
Youth was deemed to extend to 45 years and an honorarium of £200 was provided courtesy of the Irish Heart Foundation. Subsequently this prestigious invitation was broadened to embrace mature cardiologists with Irish connections. Paul Doherty and W.M. Fennell were our first two lecturers.
November 23rd, 1979
In many ways this date was a watershed for the Society. Importantly it marked our first meeting in Belfast at the rooms of the Ulster Medical Society. Energetic promotion and preparation by Scott and Horgan ensured a large successful meeting with 14 presentations on Saturday morning and competition for places on the programme, in marked contrast to the difficulty in devising a full programme in previous years. The situation was further helped by the active recruitment of registrars in specialist training as associate members, as decided on November 18th, 1977.
The Eighties
Membership had now risen to 70. Associate membership was in the process of active development and members' wives were invited to dinner. The annual subscription had risen to £20 and the Society had acquired official notepaper and an emblem. Successful joint meetings were held with the Corrigan Club to mark the Centenary of Dominic Corrigan's death, with the Irish Thoracic Society and with the Maryland Heart Association.
The first half of the decade featured numerous presentations relating to the development of coronary angioplasty. As success rates rose and complication rates fell the problem of restenosis emerged to dominate the scene. The second half of the decade was dominated by the emergence of thrombolysis in the management of acute myocardial infarction. Stokes lecturers Hugenholtz (1987) and Swan (1989) addressed this topic. There were numerous hospital reports and the prospect of pre-hospital thrombolysis was developed particularly by Varma.
The interventional cardiologist was now using dilating balloons for aortic and pulmonary stenosis (Duff and Oslizok), and the Inoue balloon in mitral stenosis (Khan and Crowley). Valvuloplasty for aortic stenosis made a brief disappointing appearance (Moore). By this time our cardiac surgeons were very busy.
Data from the Irish Cardiac Surgery Register 1983-88 (Lonergan, Daly and Graham) reported a series of 5,156 open heart procedures, 3,615 graft surgeries with peri-operative mortality of 3.1%. There were 977 valve replacements with 4.9% mortality. The remarkable superiority of the internal mammary artery graft was reported from the National Unit with 829 cases and O'Kane et al (Belfast) reported 367 patients. The Cork experience revealed that 403 patients were reported by T. Aherne et al, the total peri-operative mortality was only two patients.
Four of our members became Founding Fellows of the European Society of Cardiology ? D. Boyle, J. Horgan, M. Scott and M. Walsh.
The Nineties
The clinical cardiologists (Campbell and Quigley) were illustrating the superior valve of trans-oesophageal echocardiography in aortic and mitral valve evaluation, Dobutamine stress echocardiography was perhaps generating more heat than light, cardiac troponins were emerging as valuable markers and prognostic indicators in acute coronary syndromes, while the contemplative physicians (Johnston and Graham) were wondering about homocysteine.
The interventionalists (Sugrue, Khan, Crean and Meany) were now employing intra-coronary stents to maintain vessel patency after PTCA. Inevitably perhaps nature triumphs and stent restenosis emerges, nasty though not common (O'Shea, Duke). The role of directional coronary atherectomy was elaborated by Khan.
An attractive feature of recent years has been the arrival of young cardiologists from UK and US centres at our meetings. This has been particularly noticeable in the relatively new field of electrophysiology. Thus radio frequency ablation in WPW syndrome was addressed by de Buitlear and Keelan Wisconsin (1990-95) with further presentations with regard to transvenous implantable defibrillators (1995).
Hospital practice in relation to acute myocardial infarction was recorded by the IHF Register, which evaluated 776 admissions to the 40 CCUs within the Republic. The average time from pain onset to hospital admission was five hours, however only 41% actually received thrombolytic therapy.
Our surgeons (Hurley, Neligan and Wood reported their five year experience with heart transplant - 40 patients, 35 hospital survivors with 31 medium and long-term survivors.
A large successful series of children with coarctation of aorta, 178 infants over 15 years and 121 older children with infantile coarctation and hypoplastic aortic arch were treated over 11 years. Wood reported on 230 cases of mitral valve reconstruction over a 12 year period. The Stokes lecturers throughout the decade were Donald Ross, John Geddes, R. Frye, J. Keane. T. Treasure, William McKenna, H. Dargie and Kevin Walsh.
Present Day
Current membership of The Irish Cardiac Society
- Full members - 120
- Associate members - 30
- Extraordinary members - 11
- Honorary members - 6
- Lifelong honorary members - 2 (R. Mulcahy and J.F. Pantrage)
The Society enters the next half century in the knowledge that advancing technology and therapies will place a heavy burden on its membership. Events of the past suggest that it will be equal to the task.
