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Mark Cowley Lidwill – Inventor of the Cardiac Pacemaker

October 27, 2010

Mark Cowley Lidwill was born in Cheltenham, England on the 7th April 1878. He emigrated with his parents to Melbourne, Australia, in 1894 and later graduated with honours in medicine from Melbourne University (MB 1902, BCh 1903), and as MD in 1905. He married Constance Emily Jones in 1906 and purchased his first property in 1908 at 63 Beecroft Rd in Sydney, building a two-storey residence that is still standing today as Cook House of Arden Anglican School. Shortly after, he moved back to Strathfield, Sydney and established rooms in prestigious Macquarie Street. Most important for his later work, in 1913 he purchased an electrocardiograph, the first in Sydney; this was only a year after the first electrocardiograph was imported into Australia by MD Silberberg of Melbourne (Fig 1).  His machine, similar to Silberberg’s, was the size of a piano and required the subject to place both their hands, and their left foot, in glass jars filled with saline.

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Figure 1: Silberberg’s Electrocardiograph

(1913 was also an auspicious year for Lidwill as he became the first angler to catch a black Marlin (70 lb) with a rod and reel. The skeleton of the impressive fish is still on display in the Australian National Museum. Fig 2)

Cowleylidwillmarlin

Figure 2: Lidwill’s Black Marlin in the Australian National Museum (Mellor L, 2008)

Later, he would describe the electrocardiographic recordings he made upon his patients and the thoughts they would engender:

“My attention has been drawn to the failure of the neuro-muscular mechanism when watching a patient die and at the same time taking electrocardiographic tracings. The sino-auricular node first ceased to act. Then Tawarra’s node ceased and the heart kept on beating by means of extra systoles. I also notice that in certain toxaemias, one of the signs of cardiac failure was impairment of the conductivity or functioning of portions of the neuro-muscular mechanism, because, on careful microscopical examination, the muscle itself seems quite able to carry on the circulation. Then one considers the causation of the cessation of ordinary muscle to reaction from nerve impulses and, as you know, it is found that the nerve endings become fatigued and cease to act long before the muscle itself ceases to act. The muscle can still be stimulated by electrical means and will contract long after the nerve endings have ceased to act. I then thought that if I designed some means of stimulating the heart after the sino-auricular node and other portions of the system had cease to act, life might be carried on and it might be possible to revive patients from time to time.”

It is not known when Dr Lidwill began work on a primitive pacemaking device. However, he was ready to test it in 1926, describing its first successful use at the 3rd Australasian Medical Congress in 1929:

“I designed some time ago a machine by means of which direct stimulation to the heart’s muscle may be applied. It was unknown, at first, what voltage was required. Dr. Briggs who was at the Crown street Women’s Hospital, carried out experiments for me in stillborn infants. Voltage was used from 1.5 up to 120 and it was found that somewhere about 16 volts was the pressure required. The method was tried in two or three cases and was completely successful in the case of a stillborn infant, when everything else had been done to revive the child, artificial respiration, injections of pituitrin and adrenalin injected into the heart itself. After this had failed, the needle machine was plunged into the auricle and various voltages were tried with no result. The needle was then plunged into the ventricle, and the heart responded to each impulse. At the end of ten minutes the current was stopped and it was found that the heart would beat of its own accord. The child recovered completely and is now living and quite healthy.”

A working model of an updated machine was present at the 1929 congress; unfortunately, no photographs or details of the device are extant:

“The machine, as shown, requires only to be plugged into a lighting point and its use does not require very much intelligence. One pole is applied to a pad on the skin, say the left arm, and is saturated with strong salt solution. The other pole which consists of a needle insulated at its point, is plunged into the ventricle and the machine is started. It may be necessary to alter the polarity of the poles and there is a switch for doing this. When the current is applied to the apparently dead body, the whole thorax and arm contract. I think if this machine were used, it would often save lives. There may be many failures, but one life in fifty or even a hundred, is a big advancement where there is no hope at all.”

The details of this work were published in the transactions of the congress (Lidwill, 1929), and the next year in Anesthesia and Analgesia (Lidwill, 1930) – Figure 3. Credit was also given to a Major Booth of the Physics department of Sydney University who was evidently important in the technical aspects of the machine.

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Figure 3: Lidwill’s Pacemaker published in Anesthesia and Analgesia, 1930

Despite the groundbreaking nature of this work, it was pursued no further.

Dr Albert Hyman, often mistakenly regarded as the inventor of the artificial cardiac pacemaker referenced the work of Lidwill in his seminal 1932 article, mistaking him for ‘Gould’:

“In 1929 at the Medical Congress held in Sydney, Australia, Gould demonstrated an electric device for stimulating the heart; this apparatus consisted of a neutral plate and a positive needle electrode which was inserted into the heart. Gould reported the case of a baby who was resuscitated by such electrical stimulations of this organ.”

Lidwill retired at age 60, and died at 90. Ivor Hotten, his good friend, said that he had an:

“air of jollity and friendliness which radiated from his portly person topped by a shiny pate and a childlike smiling countenance which endeared him to patients and students alike” (Mellor, 2008).

MC Lidwill – inventor of the cardiac pacemaker.

Hyman AS (1932) Resuscitation of the stopped heart by intracardial therapy. II. Experimental use of an artificial pacemaker. Arch. Intern. Med. 50:283.

Lidwill MC (1929) Cardiac disease and anaesthesia. Australasian Medical Congress (British Medical Association), Sydney, Australia. Med J Austral 2:574-5

Lidwill MC (1930) Cardiac Disease in Relation to Anesthesia. Anesthesia and Analgesia 9:145-150

Mellor L (2008) Lidwill, Mark C. Faculty of Medicine Online Museum and Archive, University of Sydney.

 

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