James Mackenzie lecture 1987. Clinical medicine and the health divide.

MY mother-in-law and father-in-law live happily together in Summerseat Lane, Holcombe Brook, near Bury in Lancashire. The address of the speaker's mother-in-law must surely be the most inauspicious piece of information with which any Mackenzie lecturer has ever begun. But you will see the relevance when I tell you that I set out this year on a bitingly cold January day from Summerseat Lane which leads down to the tiny Summerseat railway station. It was through here and through an unpoetic jangle of other Lancastrian stations Bowken Vale, Besses O' the Barn, Ramsbottom and Rawtenstall that Dr Mackenzie travelled from Scotland via Manchester to Burnley in August 1879 to begin his 29 years as a general practitioner. Like most of you reading this lecture, 12 months ago I knew virtually nothing of James Mackenzie, hence my pilgrimage to his town. As a result of that visit and my study of two inordinately dense biographies about him I commend them heartily to future anxious Mackenzie lecturers as an alternative to temazepam I now know a great deal more."2 James Mackenzie practised in an elegant 'corner shop' Regency building for 29 years. Above all he was a great clinician and it is not surprising that the Burnley Postgraduate Centre is named after him. I suppose he must have looked something like Luke Filde's 'The doctor' (Tate Gallery) intensely observant, inordinately compassionate, but alas therapeutically impotent so well perceived by the distraught parents in the background. Nevertheless his accurate history taking and observation of simple things like the pulse, the neck veins, the apex beat, the respirations continuously and meticulously recorded in the same patients over 29 years coupled with the use of his selfdesigned polygraph, enabled him to describe the natural history and prognosis of atrial fibrillation, ventricular extra-systoles, sinus arrhythmia and the action of digitalis. He was always particularly proud of the work which he did in identifying benign irregularities of the heart, which since the invention of the