“General Outline of the Principles Underlying the Production of Heart Failure”—Chapter 1 in “Diseases of the Heart” by James Mackenzie, M.D., M.R.C.P. (1908)
Dr. James Mackenzie, one of the fathers of clinical arrhythmology, was born in Scotland in 1853 of humble origin and rose up to the pinnacle of cardiology in England in the early part of the 20th century. He obtained his medical degree at Edinburgh University in 1878 and entered general medical practice. While engaged in a very busy practice, he made original observations that resulted in over 50 papers published. In 1890, he made the seminal observation that the chambers of the heart could beat out of their correct order. It was during these clinical activities that he first discovered extra systoles. To record the peripheral pulse, he developed the polygraph, an ink‐writing instrument that was able to record the radial and jugular pulses. He became progressively interested in cardiology, focused on arrhythmology, and was one of the first to describe disordered irregularity of the heart beat that was subsequently called auricular fibrillation.
Dr. Mackenzie collaborated with Sir Thomas Lewis for a period of time, but their relationship became strained as these two giants contributed to the fundamentals of clinical cardiology as we know it today. An interesting sidelight occurred when Dr. Mackenzie postulated in a manuscript that digitalis reduced the ventricular response rate in atrial fibrillation by enhancing vagal tone. This manuscript was sent to the journal Heart and was rejected by the editor, Sir Thomas Lewis. Mackenzie sent a now famous letter to Lewis and said “… you might as well put upon the forefront of the journal “No articles will be accepted which are not in accordance with the (temporary) beliefs of the Editor”… this, I suppose, is to be the end of our collaboration.”
In 1908, Mackenzie published his book, Diseases of the Heart. 1 The book was an outgrowth of the observations Mackenzie made on patients with disorders of the heart during an active practice of over a quarter of a century. The first chapter of the book entitled “General Outline of the Principles Underlying the Production of Heart Failure” is reproduced in its entirety in this “History of Electrocardiology” section of the Annals. In this chapter, he defines heart failure, reflects on the role played by the exhaustion of the reserve force of the heart muscle in the development of heart failure, and highlights the contribution of the irregular action of the heart to inefficient performance of the heart. The book is written from the standpoint of the symptoms of the patient, with each symptom interpreted in terms of its physiological meaning.
Sir James Mackenzie uniquely combined patient care with academic scholarly work in cardiology and research in general practice. His accomplishments and contributions provided the foundation for the rapid advances in medicine and cardiology that ensued in the 20th century.
REFERENCE
- 1. Mackenzie J. Diseases of the Heart. London ,Oxford University Press, 1908. [Google Scholar]