James Mackenzie was a Scottish physician and one of the leading cardiologists in Europe during the first two decades of the 20th century. In 1892, he introduced the polygraph and was able to obtain simultaneous tracings of the arterial (radial or brachial) and venous (internal jugular) pulses. The device was also designed to record the apex beat, carotid or liver pulse and finally the respiratory movements. From 1906, he used continuous rolls of paper to register longer tracings with the ink polygraph. This was a small and portable device which could be used on everyday clinical practice.
He published his classic monograph entitled, "The study of the pulse," in 1902.
Mackenzie studied extensively the venous pulse and his tracings showed the presence of multiple waves. He then analyzed these different waves according to the cardiac cycle. Mackenzie showed that the venous pulse represented the atrial pressure. He also showed that the v wave of the venous pulse appeared earlier and was larger in patients with tricuspid regurgitation compared to healthy patients. In this section of his book, he studied several individual cases illustrating the changes in the venous and liver pulses in patients with valvular heart disease including rheumatic mitral valve stenosis with tricuspid regurgitation.
The chapter 20 of the book is entitled, "Paralysis of the auricle and the ventricular form of the venous pulse." Mackenzie used the term "atrial paralysis" as he could not identify any atrial activities in the pulse tracings of some of his patients. He was not able to understand the mechanism or clinical relevance of this arrhythmia which was in fact typical atrial fibrillation as we know it today. Mackenzie, however, noticed that the irregularity of the arterial pulse was associated with a characteristic shape of the venous pulse. As the latter had a prominent systolic wave, he named it "the ventricular form of the venous pulse". Among the cases that he described, were patients with rheumatic mitral stenosis and regurgitation and "paralysis of the auricle." Later on, the observation of atrial hypertrophy in autopsy studies led him to abandon his view on paralysis and influenced him in concluding that the atria still had persistent but disorganized electrical activities.
In his monograph, Mackenzie summarized the characteristics of the venous and liver pulses in patients with mitral stenosis as follows:
Mackenzie did many other significant observations on the rhythm of the heart including identification of extrasystoles as early as 1890 and disorders of conduction.