Biography

James Mackenzie was born April 12, 1853, on the outskirts of Scone, Scotland, and was educated at the Perth Academy, then at the University of Edinburgh, from which he graduated in 1878. In 1879 he began a general (medical, surgical, obstetrical) practice and was briefly house physician at the Edinburgh Royal Infirmary. He received the Doctorate of Medicine in 1882 became Physician to the Victoria Hospital, in Burnley, Lancashire, an industrial town, where he remained for 28 years, married, had two daughters and laid the foundation of his practice, research, publications and increasingly widespread recognition.

In 1907 he was appointed Physician to the Mount Vernon Hospital and moved to London where, in 1913 he was appointed to the London hospital. In both he organized a cardiac outpatient clinic and a cardiac ward to which he attracted assistants and colleagues, and mentored many young physicians and continued pursuing research. He became a Fellow of the Royal Society, lectured and taught widely, was frequently honored and Knighted. By 1908 he began to suffer progressively more severe angina pectoris, but continued to work for another decade. During the First World War he established a special military hospital for soldiers disabled because of cardiac illness. In 1918, increasingly disabled, he left practice and founded and single-handedly funded the Institute of Clinical Research in St. Andrews Scotland, a University town with a stable population, where he intended to study the symptoms and progression of disease from its earliest manifestation. Within a year the harsh northern climate forced his return to London where he remained until his death.

When he began practice and investigation, the only instrument for the study of heart diseases was the stethoscope (the electrocardiograph was introduced in 1903) but he had been influenced by the study of cardiac physiology and pathology of the last quarter of the nineteenth century during which Gaskell and Marey and Chauveau, among the others had demonstrated the value of recording physiologic function. The Dudgeon Sphygmograph was an early device capable of recording the radial pulse on a smoked drum. He added tambours to record jugular venous and hepatic pulsations and in clinical and research efforts studied the venous pulse extensively, demonstrating that the pulse was a major indicator of cardiac irregularity and the nature and severity of cardiac disease. As the sphygmograph recorded a single arterial channel only, Mackenzie demonstrated the additional information that could be derived from recording several pulses simultaneously and modified the device into a portable multichannel recorder, he named the clinical polygraph with the capability of simultaneously recording the radial pulse, the jugular venous pulse and hepatic pulsations. Later, with a watchmaker, Mr. S. Shaw he devised a clock work driven ink polygraph direct writer which produced a more easily performed and interpreted recordings he used for the remainder of his investigations. He continued to publish venous and arterial tracings during his clinical research and investigations and did not use the electrocardiograph.

Beginning in 1892 he published venous pressure curves associated with and diagnostic of cardiac disease. He was the first to associate the venous and arterial pulses, emphasizing the timing relationship of contraction of the various cardiac chambers. He investigated the irregular action of the heart, the action of digitalis, and studied atrial (then called auricular) fibrillation and prognostically distinguished between cardiac irregularity resulting from atrial fibrillation, and ventricular extra systoles.

He proposed an hypothesis of referred pain in which a diseased viscus projects pain onto the body surface but not directly over the affected organ, with hyperesthesia skin reflection of diseases of specific organs, and hypothesized that the pathway was via the spinal cord and the sympathetic nervous system. He also described the neural distribution of herpes zoster along an affected nerve. He carefully defined angina pectoris and published what was then the definitive monograph, "Angina Pectoris" in 1923 and published other clinical and research studies in the British Medical Journal, the Quarterly Journal of Medicine and Medical Chronicle and "The Study of the Pulse" in 1909. His major work "Diseases of the Heart" published in 1908 and extensively illustrated with venous and arterial tracings rapidly became the major cardiology text. In 1916 he published "Principles of Diagnosis and Treatment in Heart Disease" and in 1919 "The Future of Medicine", an effort to direct posterity.

In 1909 he proposed Thomas Lewis as the editor of the first English language journal devoted to cardiac studies, HEART, "A Journal for the Study of the Circulation", the editorial board of which included members from the United Kingdom and North America and occasionally Europe. He contributed multiple articles to HEART and other journals until his death of persisting cardiac disease in 1925.

- Marleen Irwin