history 69 doi:10.4997/JRCPE.2012.117 [email protected]

the following year, and in year, the following 5 2012; 42:69–74 2012; Edinb Physicians Coll J R +44 (0)1382 630041 (0)1382 +44 G Lowe, to G Lowe, Correspondence Drive, Glamis 3 Greengaites, 1QG DD2 UK , tel. e-mail This book was pivotal in the was pivotal This book 3 © 2012 Royal College of Physicians of of Physicians of College Royal © 2012 Impressed by the depth of Mackenzie’s work, work, the depth of Mackenzie’s by Impressed 4 1913 was appointed Physician-in-Charge of the first the of Physician-in-Charge appointed was 1913 . London The department cardiac at UK in the as such men inspired and together he gathered Here were whom of both Parkinson, John and Lewis Thomas up set Lewis and he I, War World During knighted. later the on Hospital in Hampstead Vernon a study at Mount many distinguished medical figures from around the around from medical figures distinguished many including the celebrated Canadian physician world, Karel Viennese cardiologist William Osler and Dutch-born to his out-of-the-way made the journey Wenckebach, home.Lancashire in acclaim the time received that at not had Mackenzie from him country own his afforded being was that to in order in 1907 London to moved he so overseas, published He views. radical his on fully more expound The Heart work his definitive observation of large numbers of patients and repeated observationrepeated and patients of numbers large of early an from main interests His records. his of analysis cardiac and in general, disease cardiovascular were stage the in him aid To in particular. women pregnant in failure pulsationhe made of heartbeatanalysis irregularities a modified Dudgeon sphyg- with initially recordings, pulsations venous him to record that allowed mograph his by later ownfollowed arterial, with simultaneously In ink-writing polygraph. multichannel the invention, pain-staking single-handed of years 28 after 1902, in he published the results observationsrecordings, and The Study of the Pulse. development of cardiology and by this time he had of cardiology and by development the on clinical authority world the become undoubtedly heart. Sharpey later Sharpey 1 The paper also describes the transformation also The paper Born at Pictstonhill Farm on the outskirts Born at of This paper gives a brief account of how doctors who were either native either native doctors who were a brief account of how gives This paper 2 ames Mackenzie Retired Dermatologist and Honorary Curator of Tayside Medical History Museum, Dundee, Scotland, UK Dundee, Scotland, History Museum, Medical of Tayside and Honorary Curator Retired Dermatologist Paper G Lowe handed it on to his half-brother James Arrott, who in who Arrott, James half-brother his to on it handed studying for 1837 set up the first institution in Dundee this, as such items Historic chest. the of diseases med- illustrate vividly explanatorycomplemented by text, This time. over ical advances and changing patterns of care of patients with heart the care disease outlines how paper Hospital up to the opening of Tayside in evolved and details the most notable and in 1974, contributions to cardiology made either within the region, their work to Images relating elsewhere. its natives or by website: can be seen on the Museum’s www.dundee.ac.uk/museum/medical.htm Scone, in whose ancient Abbey Scotland’s kings had been had kings Scotland’s Abbey ancient in whose Scone, was Mackenzie upon the Stone of Destiny, crowned At an as a clinical investigator. greatness destined for busy general practice in the mill town of his stage early was a lack of understanding there he realised of Burnley signs and significance of the symptoms of the cause and This prompted work. in his everyday he encountered that clinical careful and prolonged through an investigation ABSTRACT of development early the helped to shape Tayside in working to or actively important how contributions to the understanding and It exemplifies cardiology. team, individual or an inspired an exceptional can be made by practice of medicine The might appear. their work the initial setting for unlikely no matter how the understanding and fostering in played that Sir James Mackenzie role remarkable infancy is outlined. of this speciality in its ainto War World Second the after facilities meagre Infirmary’s Royal Dundee of effect in becoming cardiologyin excellence of services centre dynamic 1960s, the in andteaching care, clinical of ‘embedding’ acclaimed highly the for prototype a Hospital and Medical School in Dundee. Ninewells at the new research Infirmary Dundee Royal James Mackenzie, Sir Tayside, rds Cardiology, Keywo (later Professor) Dr of is the son ions of Interests Dr Lowe Declarat article this from Sections article. in this described is who Lowe, Gordon Kenneth website. Medical History Museum’s Tayside been published on the previously have Tayside’s contribution to the early development development early the to contribution Tayside’s cardiologyof This account must start with Sir James Mackenzie startThis account must Mackenzie Sir James with British in shaping figure who was the key (1853–1925), cardiology. Sir J Tayside Medical History Museum is fortunate to have in HistoryMedical fortunateis Museum have to Tayside time one at that stethoscope wooden a collection its René instrument. that of inventor the to belonged William this particularto stethoscope given Laënnec had the as to often referred of native a Sharpey, in Britain. physiology’ modern ‘father of G Lowe

so-called ‘soldiers’ heart’, where assessment concentrated The beginnings of Cardiology in Dundee on functional efficiency of the heart rather than the presence of supposed or dubious anatomical lesions, a Mackenzie recognised the value of the electrocardiogram major shift in assumptions. This led to a re-definition of (ECG) machine but was concerned that doctors would the disorder as ‘effort syndrome’ and allowed thousands get too fond of instruments and allow their clinical of men to be declared fit for active service. Mackenzie senses to atrophy.10 Despite these misgivings the first introduced objectivity and measurement to the ECG duly arrived at (DRI) in understanding of cardiac irregularities, in particular 1924, the year before he died. The £350 purchase price showing the harmless nature of extrasystoles and sinus was met by St Andrews University, with the Infirmary arrhythmia, and rationalising digitalis therapy, major responsible for the running costs. This somewhat developments in his field. He is perhaps best known for cumbersome machine (Figure 1), which according to the his recording of the disappearance of the ‘a’ wave of local press was acquired ‘to probe the secrets of the atrial contraction from the jugular pulse and the pre- heart’,11 was placed under the charge of Dr William systolic murmur of mitral stenosis with the onset of Malcolm (1871–1936). A native of Blairgowrie in what he recognised as ‘paralysis of the auricle’, later to Perthshire, Malcolm was both a GP and Assistant be identified as atrial fibrillation. He continues to be Physician at DRI and also served as cardiologist and recognised for this development; in 1998, the Royal medical specialist to the Ministry of Pensions. He College of Physicians of Edinburgh organised the Sir James published articles in the British Medical Journal on ‘Right Mackenzie Consensus Conference on Atrial Fibrillation at Branch Bundle Block [sic]’ in 192712 and ‘The St Andrews. (Supplement available at: http://www.rcpe. Electrocardiograph and Alternating Current Interference’ ac.uk/journal/supplements/supplement-6.pdf. in 1931.13 In his BMJ obituary he was described as ‘Electrocardiographer’; the directors of the hospital paid Despite his success and the honours he earned, including tribute to the care, precision and devotion to his a knighthood and election as Fellow of the Royal Society pioneering cardiac work. It is evident that he was a man (FRS), Mackenzie gave up his lucrative practice in of talent and wide accomplishment; he could be London in order to return to his general practice roots, considered as the progenitor of cardiology in Dundee’s where he felt that the significance of early signs and medical school.14 symptoms of disease could best be studied by long-term follow-up of patients. He relocated to St Andrews in 1918 to found the innovative Institute for Clinical Research in a handsome Victorian villa on the Scores, where the general practioners (GPs) of the town could work collaboratively under Mackenzie’s leadership. Two years later he was appointed Physician to the King in Scotland. The Institute can be regarded as the first step in the establishment of general practice as a specialty with a unique clinical and research role and its founder is rightly revered as the father of research in general practice.6 Although his Institute closed its doors in 1944, it left behind a group of records which are still used to this day.7

Mackenzie himself had suffered from cardiac pain since 1908, and indeed was ‘Case 28’ in his own book Angina Pectoris,8 published in 1923. He died shortly after Figure 1 The first ECG machine in Dundee. (Dundee Advertiser 1924 © , D C Thomson & Co Ltd) developing severe cardiac pain while at a Burns Supper in London in 1925. In accordance with his express wish, his heart was removed by his loyal assistant John Malcolm was succeeded as electrocardiographer by Dr Parkinson and sent to David Waterston, the Professor of Alexander Macklin (1889–1967) who had settled in Anatomy at St Andrews University, who with the help of Dundee in 1925 as a GP, with anaesthetic duties at DRI. DF Cappell, Professor of Pathology in Dundee, wrote up Macklin was a man of many parts. After his great the morphological features in the British Heart Journal.9 adventure as a surgeon on the 1914–7 Imperial Trans- To this day, Sir James’s preserved heart is on permanent Antarctic Expedition with (where all display at St Andrews University’s Medical School, where were miraculously saved from ), he it serves as an inspirational icon for medical students. returned to the Antarctic with Shackleton in 1921 history where he had the grim task of confirming at postmortem examination his leader’s fatal coronary heart disease. Army service in World War I gained him an MD based

70 J R Coll Physicians Edinb 2012; 42:69–74 © 2012 RCPE history

71 He was appointed He was appointed 17 Hill’s first research priority on first research Hill’s 16 Howard Burchell from the Mayo clinic nominated the Mayo from Burchell Howard 18 Tayside’s contribution to the early development of cardiology contributionof cardiology development the early to Tayside’s Senior Lecturer in Medicine at the University of St of the University in Medicine at Senior Lecturer other and bring these able to was and in 1952, Andrews cardiac In Hill’s techniques to Dundee. research room turret in a cramped accommodated laboratory, was one of the first in Lowe 8 at DRI, Ward beside Scotland to use right heart catheterisation in the pre- and with rheumatic patients of assessment operative 2). heartcongenital (Figure disease Emslie- in 1954 of Dr Donald With the appointment after soon followed registrar cardiac 1922) as Smith (b the Dundee (1923–2001), Watson that of Dr Hamish by on intracardiac initially focused interest research unit’s catheters. (IEG) using electrode-tipped electrocardiography right ventricular The patterns in the normal heart, pre- branch block and ventricular bundle hypertrophy, of the recording and simultaneous studied, excitation were patients pulse during catheterisation of IEG and pressure with pulmonary stenosis helped in identifying the site of In a tract. outflow the obstruction in the right ventricular of the British on 50 years Heartpersonal reflection Journal in 1989, arriving in Dundee was to set up a cardiac diagnostic cardiac a up set to was Dundee in arriving in part cardiac to support the need to develop laboratory, holder of the Chair of Despite being the third surgery. and his secretarial for office and rooms his own Medicine, within a mansard created medical staff had to be newly of the Medical School. roof the first cardiac performed Forsmann Werner In 1929, This technique himself) in Germany. (on catheterisation Cournand by 1940s the in formally more refined was Medical Center in at Columbia University and Richards Sharpey- Peter and McMichael John In the UK, York. New the at studies catheter cardiac pioneered Schafer Hospital at Hammersmith Medical School Postgraduate World the Second from return on his where in London, expertise in the technique when acquired Lowe War of and in the diagnosis flow blood measuring renal later teamed up with Lowe congenital heart disease. Robert radiologist and Goodwin John cardiologist supplement a as angiocardiography introduce Steiner to studying the pulmonary catheter service, to the cardiac varyingand in patients with mitral stenosis vasculature of pulmonarydegrees hypertension. directed Hill’s attention to Craib’s studies on the on the studies Craib’s attention to Hill’s directed electrocardiography, of basis physiological fundamental physiologists. by long taught concepts which challenged of fathers founding three the of one Wilson, N Frank and Willem Einthoven with (along electrocardiography similar published independently had Lewis), Thomas Sir of recipient As a similar conclusions. reached and studies at and 1930s in the Fellowship Travelling Rockefeller a ‘Heart famous Wilson’s to went Hill instigation, Ritchie’s importantdid he where Michigan in Arbor Ann at Station’ the In 1950 he explained on electrocardiography. work influential doctors in a highly V leads to UK unipolar new article in the Lancet. In 15 II orld War after W 14 th ow 2012; 42:69–74 2012; J R Coll Physicians Edinb Coll Physicians J R © 2012 RCPE Exponential gr with the induction inAll this was to change dramatically distinguished Ian Hill (1904–1982) and 1951 of the already Donald Douglas (1911–1993) as the first full-time at the of Medicine and Surgery respectively, Professors personalitiesdriving These Andrews. St of University andpatients cardiac of care the in closely collaborated their departments on to transform into dynamicwent inter- and national achieving units academic modern national military recognition. Both men had been awarded They knighted. later were and II War World during honours respective their of Presidents ever first the became and held outwith the capital, Edinburgh Colleges from in Queen the to Surgeon and Physician as appointments It was to be a golden at a later date). Scotland (as did Lowe with basic and clinical research, dominated by period, Dundee at the cutting edge of advances in cardiology. team created medical A professorial Ian Hill was heavily career, postgraduate In his early Dr physicians Edinburgh the distinguished influenced by The latter had WT Ritchie. R GilchristProfessor and and on auricular flutter in 1914, published a monograph on his work in the North Russian Winter Campaign. He Campaign. Winter Norththe in Russian work his on Military OBE, Medal, Polar of the the recipient also was Stanislaus. St of Imperial Order the and Cross addition, Mount Macklin in Georgia is named after is named Macklin in South Georgia Mount addition, to On his return doctor. a for honour an unusual him, he was disappointed II, War World DRI after service in anaesthetic his and ‘in chaos’ departmenthis find to charge to take his post He resigned scattered. records University, Aberdeen Serviceof the Student Health at to fill the Clark was appointed Gordon and Dr John DRI. at vacancy the (1917–2010) Lowe Gordon Kenneth Macklin taught remembered Lowe clinical examination. of rudiments ongoing an for student medical a as interviewed being he and in 1936, Institute Research Mackenzie’s at study Before after the war. to his alma mater later returned Professor DRI by at taught medicine was II, War World attachments. with hospital GPs by assisted Patrick, Adam his private practice for on dependent was largely Patrick The own. his office of personal no had and income, than more little academic department of medicine was that remembered Lowe outpatient rooms. and wards very familiar with Sydenham’s students of the time were rheumatic heart aortitis disease and syphilitic and chorea, coronarybut importancethe knew hypertension, of heart for disease Treatments uncommon. was disease peripheral oedema, tubes for Southey’s included bed rest, for pheno-barbitone failure, left ventricular morphine for tablets of digitalis leaf and mercurial and high blood pressure, entry frequent a was degeneration’ on ‘Myocardial diuretics. of heart understanding that showing death certificates, disease was vague at that time. G Lowe

Hamish Watson’s interest in paediatric cardiology stemmed from the tragic death of his only son from congenital heart disease, and culminated in his editing a standard textbook on heart disease in children, and his founding of and election as the first President of the European Association of Paediatric Cardiologists in 1963. At its 1967 meeting in Rome, Hamish addressed the Pope on behalf of the Association on some of the ethical problems related to congenital heart disease. He pioneered the use of selective cine-angiocardiography with image intensification in children with congenital heart disease with Dr Cecil Pickard from the Department of Radiology, and was the first in the UK to perform atrial septostomy as a life-saving palliative procedure in babies born with transposition of the great arteries.23

The most exciting intracardiac work for Hill’s team was the search for evidence of conduction along the Bundle of His. Figure 2 Dr KG Lowe (centre) performing an early This was eventually found and recorded in a teenage girl cardiac catheterisation at Dundee Royal Infirmary. Dr C with Ebstein’s anomaly of the tricuspid valve. Publication of Pickard from radiology is at far left. Professor Hill is just seen 24 (blue arrow) standing behind the nurse second left. (Courtesy the findings in the American Heart Journal in 1967 was later of Tayside Medical History Museum, cited by Science as one of the most influential scientific Museum Services) reports in a review of some four thousand articles on important cardiovascular and pulmonary subjects,25 and led Emslie-Smith’s 1955 paper on ‘The Intracardiac Electrogram to an invitation to Emslie-Smith from the distinguished as an Aid in Cardiac Catheterisation’19 as one of the three American cardiologist Hans Hecht to address an landmark papers from the second decade of the Journal. international symposium in Chicago. With more sophisticated equipment available, a flurry of research In 1955, Emslie-Smith spent a year in Melbourne with a activity on ‘His Bundle recording’ quickly followed in Travelling Fellowship, where he studied the ECG pattern America, and led in time to ablative therapy of arrhythmias. in experimental hypothermia. He elucidated the whole electrocardiographic syndrome of hypothermia in Spatial vectorcardiography was a further area of interest animals and man, and named the conspicuous extra from 1966–75 after Emslie-Smith had acquired the technique deflection the ‘J wave’.20 On his return to Dundee, when in Melbourne. Studies on myocardial infarction, arrhythmias routinely reporting ECGs at Maryfield Hospital, he and posture led to several publications, two PhD theses and recognised cases with characteristic ECG patterns of a number of lecture invitations. Emslie-Smith and Lowe also hypothermia, and was able, by recording rectal presented this topic in Sir John McMichael’s 1968 Festschrift. temperatures with a long laboratory thermometer in acute admissions, to clarify the clinical picture of Professor Hill’s team spent much of their time teaching. accidental hypothermia and emphasise its importance in Regular Easter postgraduate cardiology courses proved the community21 (at that time traditional clinical thermo- very popular, with many of the delegates attending from meters were unable to detect critical hypothermia). He overseas (Figure 3). A number of symposia with cardiology was the first to show that elderly people in the UK topics were also arranged, attracting distinguished national could become dangerously hypothermic in their own and international figures. Dundee Medical School’s homes; further work on this subject with Dr Derek reputation as a cardiac centre of distinction was growing, MacLean led to a monograph,22 invitations to meetings in and in 1963 Professor Hill was able for the first time to the UK and overseas, and an advisory role in the attract the elite Association of Physicians of Great development of low reading thermometers. Britain and Ireland and the British Cardiac Society (now much enlarged and renamed the British Cardiovascular Having been invited to work at the Hammersmith Society) to Tayside. Hospital where he was Sir John McMichael’s Senior Registrar from 1958–61, Emslie-Smith acquired the left Cardiac surgery heart catheterisation technique which, with the assistance Cardiac surgery was pioneered in Dundee by the of the radiologist George Howie, he subsequently technically gifted general surgeon Frank Brown, who introduced in Dundee. He was also awarded a Lown performed cardio-omentopexy for angina pectoris in history cardioverter by the British Heart Foundation on a the late 1930s and commenced ligation treatment of research grant, which was soon used frequently in the patent ductus arteriosus in 1945. Donald Douglas’s routine treatment of patients with atrial fibrillation. professorial appointment in 1951 led to the Dundee

72 J R Coll Physicians Edinb 2012; 42:69–74 © 2012 RCPE history Br 73 and established 28 A transition in cardiology: the Mackenzie Lewis era. The era. Lewis Mackenzie the cardiology: in transition A Sir James Mackenzie MD General Practitioner 1853–1925. Practitioner MD General Sir James Mackenzie Dr Stuart Stewart and Bill (with the McGowan 27 1939; 1:237–48. http://dx.doi.org/10.1136/hrt.1.3.237 1:237–48. HeartJ 1939; Mair A. 261. p. 1973. Livingstone; Churchill & London: Edinburgh 1924. 10 June Advertiser, Dundee Taylor DW. The life and teaching of William Sharpey (1802–1880) William Sharpey of teaching and life The DW. Taylor 15:126– Med Hist 1971; in Britain. Physiology’ ‘Father of Modern 241–59. 53; Br HeartJ cardiology. British of modern Krikler DM.The roots http://dx.doi.org/10.1136/hrt.62.3.230 62:230–4. 1989; and and hepatic, venous, arterial, The study of the pulse, J. Mackenzie 1902. J Pentland; Young Edinburgh: of the heartof the movements . J. McMichael p.4. 1976. College of Physicians; Royal London: Harveian of 1975. Oration Hodder Henry Frowde, London: Diseases of the heart. J. Mackenzie 1908. & Stoughton; An Clinical Research: for Institute Andrews St The J. MacNaughton 46:549–68. Med Hist 2002; experiment in collaboration. early 2011. communication personal Jackson Cathy Professor & Hodder Henry Frownde, Angina pectoris. London: J. Mackenzie 1923. Stoughton; heart. Mackenzie’s James Sir DF. Cappell J, Orr D, Waterston

Tayside’s contribution to the early development of cardiology contributionof cardiology development the early to Tayside’s 10 11 References 1 2 3 4 5 6 7 8 9 Conclusion activity, centurya research cardiac of covers paper This Despite clinical work. routine from which all stemmed Infirmary in Dundee Royal the minimal facilities available increased results published War, World Second the after fame department’s the and time, with exponentially research and teaching clinical care, integrated The grew. in cardiologypractised old the was at that model all departmentsto infirmarythe at spread successfully it where Medical School, Hospital and Ninewells new accumulated The ‘embedding’. as known became seem in this account described of those achievements with region Scottish small relatively a for commendable million. half a than less population of a Acknowledgements Stuart Pringle who originally I am indebted to Professor and predecessors his department’s research me to asked late father and to my write a short posterity, account for Bill Donald Emslie-Smith, Lowe, Gordon Kenneth their support for help with and Lyall StewartMike and fruition. bringing it to the DRI cardiac arrest service, which eventually became a which eventually service, arrest the DRI cardiac anaesthetist. duty resident commitment of the help of the Regional Physics Department) anddesigned Physics Regional the of help trolleys arrest cardiac built a series of early base monitoring and biochemical response to open response and biochemical base monitoring S Stewart Dr Bill Stewart and Mr John heartsurgery. man with young of a resuscitation the heroic reported the where hyperkalaemia complicating arrest cardiac a and two for massage open cardiac performed surgeon the important learning point was that it was half hours; intravenous by was corrected acidosis not until the patient’s that satisfactorysodium bicarbonate was action cardiac secured. 2012; 42:69–74 2012; Cardiology course participants, Dundee Royal Dundee Royal Cardiologyparticipants, course The noted American cardiac surgeons Michaelsurgeons cardiac American noted The 26 Figure 3 Figure D Emslie-Smith IGW Hill, KG Lowe, 1962: March Infirmary, ninth and sixth, fourth, seated respectively are Watson and H Cardiology Chief of at Dr RM Marquis, the left. tenth from Infirmary 1964–78 is seated seventh Edinburgh Royal from by taken Original private collection. Author’s left. from Dundee. and Co, Norman Brown J R Coll Physicians Edinb Coll Physicians J R © 2012 RCPE surgical unit becoming a recognised centre of clinicalof centre recognised a becoming unit surgical Born and surgery. excellence in the field of cardiovascular Douglas was the first British Andrews, educated at St Clinic at the Mayo work research to do surgeon and a happy and LaboratoryResearch in Minnesota, in Learmonth with Sir James association productive in his interest Edinburgh after the war was to stimulate surgery. vascular of then the infant specialty what was closed mitral Douglas began performing At DRI, of the with the development and in 1952, valvotomies open heart surgery valve for pump-oxygenator, Melrose heartcongenital and regularly was disease replacement which time 401 by In 1965, in the 1960s. performed heartrheumatic for performed been had operations Douglas and his disease of the mitral and aortic valves, theirreported Walker F William colleague surgical congenital heartexperience of 251 operations for disease. De Bakey and John Kirklin developed close ties with Kirklin developed and John De Bakey In operations at DRI. and both performed Douglas’ team, needthe and patients suitable of numbers dwindling time, cases recurrent complex expertisecentralise to more for longer pump times led to open heartrequiring surgery continued valvotomies mitral although Dundee, in ceasing Hospital opened in 1974. Ninewells until shortly before thein figure international an become to on went Walker with established, He disease. peripheral vascular field of in one of the first vascular laboratories Spence, Vance Dr of Association of the President elected was and UK, the in 1984. Britain and Ireland Surgeons of Great reversal arrest Cardiac in in Dundee interest research a were studies Acid-base and Dr Gemmell Morgan Walker William with the 1960s, the Dundee experience in acid- on publishing papers G Lowe

12 Malcolm WS. Right branch bundle block. BMJ 1927; 1:372–3. http:// 21 Emslie-Smith D. Accidental hypothermia: a common condition dx.doi.org/10.1136/bmj.1.3451.372 with a pathognomonic electrocardiogram. Lancet 1958; 2:492–5. 13 Lethlean NG, Malcolm WS. The electrocardiograph and alternating http://dx.doi.org/10.1016/S0140-6736(58)91283-2 current interference. BMJ 1931; 2:1195. http://dx.doi.org/10.1136/ 22 MacLean D, Emslie-Smith D. Accidental Hypothermia. Oxford: bmj.2.3703.1195 Blackwell Scientific Publications; 1977. 14 Professor KG Lowe personal communication 2009. 23 Watson H, Rashkind WJ. Creation of atrial septal defects by 15 Levack ID, McGowan SW. Alexander Hepburne Macklin: physician, balloon catheter in babies with transposition of the great arteries. polar explorer, and pioneer. BMJ 1993; 307:1597–9. http://dx.doi. Lancet 1967; 289:403–5. http://dx.doi.org/10.1016/S0140-6736(67)91172-5 org/10.1136/bmj.307.6919.1597 24 Watson H, Emslie-Smith D, Lowe KG. The intracardiac 16 Hill IG. Multiple-lead electrocardiograms. Lancet 1950; 1(6613):985– electrocardiogram of human atrioventricular conducting tissue. 91; 1(6614): 1027–33. Am Heart J 1967; 74:66–70. http://dx.doi.org/10.1016/0002- 17 Goodwin JF, Steiner RE, Lowe KG. The pulmonary arteries in 8703(67)90041-5 mitral stenosis demonstrated by angiocardiography. J Fac Radiol 25 Comroe JH Jr, Dripps RD. Scientific basis for the support of 1952; 4:21. http://dx.doi.org/10.1016/S0368-2242(52)80038-7 biomedical science. Science 1976; 192:105–11. http://dx.doi. 18 Burchell HB. Golden Anniversary of the ‘British Heart Journal’. org/10.1126/science.769161 BMJ 1989; 298:70. http://dx.doi.org/10.1136/bmj.298.6666.70 26 Douglas DM, Walker WF, Breckenridge IM et al. Congenital heart 19 Emslie-Smith D. The intracardiac electrogram as an aid in cardiac disease; a review of some surgical problems. Scott Med J 1965; catheterisation. Br Heart J 1955; 17:219–24. http://dx.doi.org/10.1136/ 10:143–58. hrt.17.2.219 27 Stewart JSS, Stewart WK, Gillies HG. Cardiac arrest and acidosis. 20 Emslie-Smith D, Sladden GE, Stirling GR. The significance of Lancet 1962; 2:964–7. http://dx.doi.org/10.1016/S0140-6736(62)90729-8 changes in the electrocardiogram in hypothermia. Br Heart J 1959; 28 Stewart WK, Mackenzie LA, Walker WF et al. Cardiac arrest 21:343–51. http://dx.doi.org/10.1136/hrt.21.3.343 trolley. Scott Med J 1969; 14:180–3.

Senior fellows’ club prize

The Senior Fellows’ Club Prize for 2011 has been won by Dr A D McCallum, for his paper entitled ‘Non-tuberculous mycobacterial infections in the Scottish Borders: identification, management and treatment outcomes – a retrospective review’. This can be seen in our December 2011 issue at: http://www.rcpe.ac.uk/journal/issue/journal_41_4/faccenda.pdf

A prize of £200 will be awarded to the first-named (or corresponding) author of an original research paper on a clinical topic, deemed by a panel of judges to be the best paper by a doctor-in-training (i.e. pre-consultant level) published in the The Journal of the Royal College of Physicians of Edinburgh in 2012. The best paper will be selected by a panel of judges, including a senior Fellow, an active clinician and a member of the editorial team.

history Further details may be obtained from the Editorial Office, RCPE, 9 Queen Street, Edinburgh, EH2 1JQ, tel 0131 247 3652 or email [email protected].

74 J R Coll Physicians Edinb 2012; 42:69–74 © 2012 RCPE