Lancashire based, Dr James Mackenzie, led a revolution in the treatment of people with heart disease
by David Hall
When one of his patients died Burnley‘s Dr James Mackenzie knew that there had been a problem he had not identified. It led him to a specialisation that was to revolutionise the treatment of people with heart disease.
Dr James Mackenzie, a Scot, was first apprenticed to a chemist and offered a partnership but rejected the offer and went on to graduate in medicine from the University of Edinburgh and got his degree of Doctor of Medicine in 1878. After a term as a house-physician in the Edinburgh Royal Infirmary he moved south to become a general practitioner in Burnley, working in Bank Parade.
He had been invited to the general practice by Dr. William Briggs and became a partner. Dr. Briggs, a clinician with remarkable powers of observation and deduction proved a great inspiration to the Scotsman. Dr Mackenzie noticed that Dr. Briggs’ skill came from his observation and the experience gained by following patients over a long period of time and that became the impelling force that motivated Mackenzie throughout his professional career. About 1883 he began a systematic study of his patients by recording their symptoms and making serial observations of their arterial and venous pulses.
Despite the high patient load in an industrial town he had many scientific papers published but it was his dealing with patients which was to identify him as a doctor who was unwilling to merely given out medicine – he wanted to know why the patient was reacting and suffering.
Recognising the lack of understanding of the basis and prognostic significance of symptoms and signs that he came across in his everyday work, he set out to investigate these through prolonged and careful clinical observation of large numbers of patients and repeated analysis of their records.
His interest in heart disease was kindled by the sudden death of a young woman who developed congestive heart failure while he was attending her delivery. Mackenzie asked himself, “would this death have occurred if I had had a better knowledge of heart afflictions?”
His main interests were cardiovascular disease in general and cardiac failure in pregnant women in particular.
He began to document his studies and discuss his findings with some of the key medical pioneers of his day.
Dr Mackenzie realised that problems of the heart were so important that they needed special
knowledge. He used an early sphygmograph to study blood pressure. That item of early equipment used levers hooked to a scale-pan in which weights were placed to determine the amount of external pressure needed to stop blood flow in the radial artery.
But Dr Mackenzie collaborated with Mr. Shaw, a watchmaker in Burnley, to produce the instrument that became “Mackenzie’s ink polygraph”. It was a clockwork mechanism powering a long roll of smooth paper and three pens attached to rubber tubes that could convey pulsations from the neck veins, heart and arterial pulses. The tracings could be recorded at length.
His interpretation of these waves remains his great contribution to that area of cardiology, the improved quality of the measurements identifying blood pulse irregularities.
It was during his years as a Lancashire general practitioner that he carried out his initial research into the problems of failing circulation, heart failure, clinical study of signs and the nature of pain. In 1885 he perfected his ink polygraph – designed to measure the activity of the ventricles and auricles of the heart. This lead to important findings on the role of ‘auricular fibrillation’ in the onset of ventricular collapse.
“I got a very serviceable instrument which I could carry about in my pocket,” was his own
description of the invention. “So easy was this after a little practice, that I could take a tracing of the radial and jugular pulse, or apex beat of a patient while the temperature was being taken, so that it was not time-robbing.”
His work on the heart soon outstripped the surgery in Burnley – although he was one of the leading lights in setting up the Victoria Hospital – and after 28 years in the town, as his knowledge increased he moved to London, becoming a consulting physician.
In his classic text The Study of the Pulse (1902), he described an instrument of his own devising that he called a ‘polygraph,’ which allowed the user to correlate the arterial and venous pulses with the beat of the heart itself. This instrument enabled him to make important and original distinctions between harmless and dangerous types of pulse irregularities.
In his text Diseases of the Heart (1908), Mackenzie summarised his diagnostic work on pulsation and cardiovascular disease. He also convincingly demonstrated the efficacy of the drug digitalis in the treatment of cardiac arrhythmias. In 1906, at the age of 54, Mackenzie attempted to establish himself in London as a heart specialist; he later worked at the West End Hospital for Nervous Diseases, the Mount Vernon Hospital in Hampstead, the London Hospital and University College Hospital.
During World War I he served as a consultant to the Military Heart Hospital, an institution he had been instrumental in founding. He was knighted in 1915 by King George V – for whom he became a honorary consulting physician in Scotland.
In 1919, wanting to return to general practice, Mackenzie founded the James Mackenzie Institute of Clinical Research at St. Andrew’s, in Scotland. Here, he intended to develop a logic of clinical research – based exclusively on the skills of the general practitioner – which would focus specifically upon the early stages of disease where diagnosis had been hitherto at its most imprecise. He used local Practitioners to detail long-term recordings of patients’ symptoms and illnesses.
Despite his enthusiasm, the project was not a success, and the Institute dissolved not long after his death in 1944 but the records are still in use and proving valuable today.
The doctor himself suffered from an irregular heart beat and he became case 28 in his book Angina Pectoris (published in 1923), He had his first heart attack in 1901 recording the abnormal heart rhythm that he suffered. He was later to get episodes of severe pains from angina until a severe angina attack while he was attending a Burns supper in London, led to his death.
An autopsy showed that he had extensive coronary artery disease.
The distinguished annual lecture at the Royal College of General Practitioners, is devoted to the memory of his name – The James Mackenzie Lecture.
In Burnley, his work is honoured by a memorial in the rose garden at Thompson Park.
A Burnley doctor, his memory lives on as a tribute to someone who saw that there was more to a doctor’s life than merely treating ailments. He wanted to prevent illness. His books and research articles are still valuable aids. In the peace of a rose garden in a Burnley park his bust looks over those passing by. The eyes which were once so quick to identify something out of the normal, now viewless.