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John MacWilliam, evolutionary biology and sudden cardiac death
1Section of Cardiology, New England Deaconess Hospital, Boston, Massachusetts.
Insights
Sudden cardiac death, often caused by ventricular fibrillation, was theorized by MacWilliam 100 years ago. His work on cardiac physiology and resuscitation remains influential in cardiology.
Area of Science:
- Cardiology
- Physiology
- Medical History
Background:
- Ventricular fibrillation is the primary electrophysiologic mechanism of sudden cardiac death.
- MacWilliam's 100-year-old theory on sudden death predates the electrocardiogram.
- His experimental methods formed the basis for modern cardiac research and resuscitation.
Discussion:
- MacWilliam identified the autonomic nervous system's role in cardiac mechanical and electrical properties, linking it to sudden death.
- His theories were influenced by Darwinian principles, utilizing comparative physiology and evolutionary concepts.
- The review examines MacWilliam's concepts in light of Darwinian influences on British physiology.
Key Insights:
- MacWilliam's foundational concepts in cardiac physiology have endured for a century.
- His work significantly influenced three generations of research and clinical cardiology practice.
- The centennial review highlights the lasting impact of his experimental and theoretical contributions.
Outlook:
- MacWilliam's theories continue to underpin current understanding of sudden cardiac death.
- Future research may further explore the evolutionary basis of cardiac electrophysiology.
- The enduring legacy of his work underscores the importance of historical physiological research.
Abstract:
Sudden death is frequently of cardiac origin, and its most common electrophysiologic mechanism is ventricular fibrillation. The concept that sudden death in human beings is due to ventricular fibrillation was first proposed by MacWilliam exactly 100 years ago, well before the electrocardiogram was invented. To conduct his experimental work, MacWilliam devised methods that laid the foundations for modern cardiac research and that provided the first comprehensive approach to successful cardiopulmonary resuscitation. He recognized the role of the autonomic nervous system in modulating both the mechanical and the electrical properties of the heart, and was the first to suggest that this effect had a role in the genesis of sudden death. On the centennial of his theory of sudden death, MacWilliam's concepts are reviewed in the context of the effect of Darwinian influence on British physiology. It is suggested that his theorem was based on both sound experimental data and comparative physiology, drawing on the new evolutionary principle of similar structure and function in the hearts of various species. MacWilliam's basic physiologic concepts have survived intact for a century, greatly influencing more than three generations of research and practice in clinical cardiology.