Professional Documents
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FIGURE 2. Ink-writing polygraph, “consisting or a tamDour ar
tacked to a Dudgeon’s sphygmograph,” developed by James
Mackenzie. Fawn Mackenzie J. Diseases oftheHeart.Pnd
FIGURE 1. James Mackenzie. (Reprinted with permission of ed. Oxford Me&al Publicatii London, 1910. (Reprinted
thCihldiC&~sectionoftheNatianaluXayofMedidna) with permission of Dxfard University Press.)
JUGULAR 3
Fro. 17.-Simultaneous tracings of the jugular and the carotid pulses. The jugular pulse is
POW of the ventricular type. Note the irregularity and the small ripples in the tracing at the
long pause +. due in all likelihood to fibrillary contra&&n of the auricle.
FIGURE 3. Jugular venous pulse tracings taken by James Mackenzie in 1906 fnwn a patient similar to the one discussed.
l&e tracings illustrate that the jugular A wave, previously recoiled, is no longer present, the arterial pulse is iwe@ular, and
small oscillations are present between the Y and the C. From Mackenzie 1. TIN interpretatronS of the pulsations on the
ju@lar veins. Am I Med Sci 1907;134:30. (Reprinted with permission of the J. B. Lippin~dt Company.)
Eventually he was able to discern 3 major jugular ve- to support his view. Later, however,basedon further au-
nous waves which he lettered “A, C, and V waves,” topsy findings of auricular hypertrophy in a patient with
postulating that their genesis was auricular contraction, the same arrhythmia, and the restoration of the A wave
the carotid impulse, and overtilling of the right auricle in patients with intermittent irregular rhythms, he ques-
and/or regurgitation from the right ventricle.4 With this tioned his concept of auricular para1ysis.sFurthermore,
device and his intuitive analysis of venous and arterial his friend, Arthur Keith, the discoverer of the sinus node
pulses, Mackenzie pioneered a new approach to clinical (along with Martin Flack) in 1907found that the sinoa-
cardiac investigation and contributed importantly to the trial node and its artery were disordered in this condi-
fundamental understanding of cardiac excitability and tion. This evidence persuadedMackenzie to believe that
conductivity as well as to the prognostic implications of the pacemakerof the heart had shifted to the atrioven-
arrhythmias.’ tricular node, producing a “nodal rhythm.“s
His interest was particularly arousedby patients with Hering, in Prague in 1903,was apparently the lirst to
an irregular pulse, for some seemedto tolerate the ir- use the term “pulsus irregularis perpetuus” and sepa-
regularity surprisingly well while others did not. He rate it from other irregular pulses. He proposed that it
posed the simple question, “What are the auricles doing was “myogenic” in origin. lo In 1899 and 1906 Arthur
when the ventricle was irregular?“* From 1880 until Cushny,i1.i2 first in Michigan and later in London, re-
1897 he had followed a woman with mitral stenosis in ported that arterial tracings in open-chesteddogs with
whom serial recordings had always shown a regular directly observed “auricular delirium or fibrillary con-
rhythm and a presystolic jugular A wave. In 1897 she traction” were similar to the radial artery tracings from
suddenly developed an irregular, rapid rhythm at which a woman with delirium cordis. He was the first to sug-
time the jugular A wave could no longer be recorded gest that the 2 conditions might be the same.8In 1899
and the presystolic murmur had disappeareds9(Figure Cushny wrote,
3). In 1902,in his lirst book, “The Study of the Pulse,”
Mackenzie published this original observation conclud- “The clinical sphygmograms in these cases resem-
ing that it was due to “paralysis of the auricle.“8 Initial bles exactly that obtained from dogs when the auricle
autopsy findings of a thin and distended auricle seemed is undergoing $brillary contractions, which may be
FlGURE 7. Electrocardiograms recoded by Thomas Lewis showing sinus tiythm in a normal patient (top) and auriculsr fibriC
lation in eeother patient @ottomJ. Ftilleting (f) waves ere demonstrated. lhis is net from the original patii mentii in
the text. From Lewis 1. Evidences of auricular fibdlatii, treated historically. Br Med I 1912;13:59. (Reprinted with pemria
sion of the British Medical Association.)