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The Legacy of Sir James Mackenzie

James Mackenzie was one of the first physicians to formally investigate heart disease and although he is often remembered as the “Father of British Cardiology” his influence extended way beyond the UK. Indeed, the New York Cardiology Society that was the forerunner of the American College of Cardiology was initially known as the Mackenzie Society.

He was born into a poor farming family in Scone, Scotland and left school when he was 14 years old. He worked as a pharmacy assistant for five years before studying medicine at the University of Edinburgh. Financial difficulties forced him to turn down the offer of an academic post when he qualified in 1878 and he worked as a general practitioner in the mill town of Burnley, Lancashire, from 1879 to 1907.

Mackenzie was intrigued by arrhythmias and initially used Riva-Rocci’s sphygmograph to record and analyse the pulse. He was very perceptive to realise that one needed to record simultaneously the activity of both the atria and the ventricles in order properly to analyse an arrhythmia. Later on, in 1893, he modified the Dudgeon sphygmograph to enable simultaneous recordings of the arterial and venous pulses, thus creating his own clinical polygraph to be used at the bedside. However the use of smoked paper with two simultaneous tracings and the short length of the recording made it a technical challenge to operate. Nevertheless Mackenzie illustrated his books with no less than 335 of his thousands of polygraph recordings. A remarkable achievement attained over many years of dedicated research in general practice.

Mackenzie discovered premature ventricular contractions in 1890 and is credited with being the first to describe atrial fibrillation by observing, in 1898, that the auricles of a patient with mitral stenosis were paralysed.

He wrote numerous papers and books including the “Study of the Pulse“, a monograph containing illustrations of 335 original recordings published in 1902. His work attracted great interest and he often discussed his findings with like-minded pioneers including Karel Wenckebach and Sir William Osier.

In November 1907 Mackenzie moved to London to work as a consulting physician. His reputation grew rapidly and he was knighted and elected a Fellow of the Royal Society. Mackenzie believed that it was only possible to identify the significance of symptoms by observing and following his patients carefully, and in 1919 he founded the influential Mackenzie Institute of Clinical Research in St Andrews so that local general practitioners could gather long-term data on their patients’ symptoms and illnesses. He founded the journal “Heart” in 1909 and played a pivotal role in establishing the Cardiac Club.

Sir James Mackenzie was the inspiration for a new generation of cardiologists in Europe, America and Britain at the beginning of the 20th century. He had a remarkable ability to dismiss widely accepted but outdated concepts and to pioneer new approaches to problems in cardiology. In particular he insisted that the recognition of the early signs and symptoms of heart failure was far better than routine documentation of cardiac murmurs. His research into cardiac arrhythmias which won him wide recognition was wholly undertaken whilst he was a general practitioner for 28 years. He was the first to clearly identify the arrhythmia which was later shown be atrial fibrillation. The British Cardiac Society has a large archive file on Mackenzie and it possesses several of his nine books.

The Mackenzie medal is the British Cardiovascular Society’s highest honour, and since 2002 has been awarded annually for outstanding services to British cardiology.

Ironically, Mackenzie himself suffered from and eventually died of ischaemic heart disease. He frequently recorded his own pulse and documented an episode of atrial fibrillation after running in 1901. He suffered with angina pectoris. In a selfless quest for knowledge he had asked his friend Dr John Parkinson to carry out a post mortem examination of his heart. Sir James Mackenzie died shortly after celebrating Burn’s night on 26th January 1925 and the autopsy he had requested showed severe coronary artery disease with evidence of old and recent myocardial infarction. His heart was preserved and remains in the archives of the University of St Andrews. The autopsy findings with detailed illustrations were published in the first edition of the “British Heart Journal” in 1939.

 

Image References
Mackenzie Ink Polygraph, 1906. This recorded the venous and arterial pulses. It was the standard method of analysing arrhythmias before the electrocardiograph.

Jugular venous and arterial tracings made by Thomas Lewis in 1909 using the 1906 ink polygraph of James Mackenzie. A paroxysm of nodal tachycardia showing giant “A” waves is recorded. The arterial trace on the bottom is with a slow paper speed and shows two paroxysms and ectopic beats.

The Mackenzie Medal awarded to Professor Sir Magdi Yacoub in 2002.