When considering the development of cardiology in general in the United Kingdom, the major influence was unequivocally Sir James Mackenzie. He was a remarkable figure, who had spent many years in general practice in Burnley, where he developed his investigative skills, prior to the development of the electrocardiogram, by using the “polygraph” to document cardiac arrhythmias, graphically recording the jugular venous pulse alongside the waveforms of the arterial pulse and other pulsations, such as those at the apex or in the liver.1 Moving to London in 1907, he established an extensive consulting practice, and became the inspiration of many aspiring physicians with a cardiological bent. This burgeoning interest led, in 1922, to the founding of The Cardiac Club, the forerunner of the British Cardiac Society.2 Initially, there were no more than 15 members, with Sir James invited to join as an honorary member. The initial members included Thomas Lewis, who along with Einthoven had developed the electrocardiogram, John Parkinson, of Wolff-Parkinson-White fame, Carey Coombs of the eponymous murmur, and a number of others, whose names are not all well remembered in the current era. Of the original members, the only one to be described by his contemporaries as a “paediatric cardiologist” was K. Douglas Wilkinson, of Birmingham (Fig. 1). He was the youngest of the founding members, having been born in 1886, and graduating from Birmingham Medical School in 1909.
Figure 1. A photograph of KD taken around 1932.
Early career
KD Wilkinson was the eldest son of an Anglican minister, who died when he was five, leaving his mother with three small children and a very limited income of about 160 pounds sterling per year. He made his way through school and university on scholarships, as also did both his younger brothers, all three subsequently graduating in medicine. Soon after qualifying, he worked as a resident at the Hospital for Sick Children at Great Ormond Street, London. He was appointed assistant physician to Birmingham Children's Hospital in 1913, having already completed his doctoral thesis on heart block (Fig. 2), for which he used Mackenzie's polygraph (Fig. 3). During the First World War, he spent several years in France with the Territorial Army Medical Corps, working with a chest unit, and co-authoring a paper on the surgical treatment of penetrating thoracic wounds.3 For his services he was appointed an Officer of the Military Division of the Order of the British Empire.
Figure 2. Tracings from the thesis submitted for the doctorate in medicine, recorded with the ink polygraph (see Figure 3), and showing complete atrioventricular block due to digitalis intoxication in a 13-year-old with rheumatic fever.
Figure 3. The original “ink polygraph”, manufactured to the design of Mackenzie, used by KD in his researches into atrioventricular dissociation.
After the war, he returned to Birmingham, where he built up a large paediatric practice, as well as an adult practice largely focussed on heart disease. In 1929, he was elected a fellow of the Royal College of Physicians. In the same year, he became the first medical graduate from Birmingham to be appointed to a professorial chair in the medical school, being appointed Professor of Pharmacology and Therapeutics. He retained that position for the next 20 years, whilst continuing with his active paediatric and adult clinical work.
Achievements
Known as “KD” to his friends and colleagues and to professional contacts, and to patients as “K. Douglas Wilkinson”, using his middle name as part of an assumed “double barrelled” surname, he was a co-founder in 1928 of the British Paediatric Association. In 1933, he contributed the chapter on “Diseases of the Circulatory System” to the new textbook on “Diseases of infancy and childhood” edited by Sir Leonard Parsons, the first Professor of Paediatrics and Child Health in Birmingham. This became a standard paediatric text in the years that followed. The chapter ran to almost 60 pages,4 though the segment on congenital heart defects filled a mere 15 pages, albeit that this was substantially larger than the equivalent section in the textbook of Sir James Mackenzie on “Diseases of the Heart”. In the 4th Edition, published in 1925,5 congenital cardiac malformations attracted but a scant 2 pages! The main interest of KD, nonetheless, was the arena of rheumatic fever and rheumatic heart disease. In 1935, he delivered the Ingleby Lecture on this topic at the University of Birmingham. He was also an authority on diphtheritic heart disease.6
During the same period, in July 1932, Maude Abbott, with whom KD had had earlier contacts, visited and stayed briefly with the Wilkinson family. He later provided her with a radiograph of a patient with aortic coarctation (Fig. 4), which then appeared in her famous “Atlas of Congenital Cardiac Disease”.7
Figure 4. Plate VIII, Fig 9. from Maude Abbott “Atlas of Congenital Heart Disease” 1936 – a radiograph showing notching of the ribs produced by the collateral circulation seen in aortic coarctation. It was provided by KD Wilkinson for the Atlas.
During the 1930s, he had the opportunity to take on a Canadian trainee in paediatrics named John Keith (Fig. 5). Keith was appointed as fellow in research into rheumatic fever, and stayed in Birmingham for a total of about five years, also doing some training in general paediatrics, as well as cardiology, at Birmingham Children's Hospital. After the Second World War, of course, John Keith established the service of paediatric cardiology at the Hospital for Sick Children in Toronto, which since that time has been such a fertile training ground for generations of paediatric cardiologists.
Figure 5. A photograph of the young John Keith, taken in 1935 during his period of training in Birmingham.
In 1935 he was one of the four members of the executive of the Cardiac Club6 that engineered its transition to become established as the Cardiac Society, initially christened “The Cardiac Society of Great Britain and Ireland”, which met for the first time in April 1937.
Subsequently, he was one of the small group who supervised the setting up of the British Heart Journal as the official organ of the society, the first number of which appeared in January 1939.6
He edited “The History of the Birmingham Medical School, 1825–1925”,8 and researched the life of William Withering, discoverer of digitalis (Fig. 6),9 about whom he delivered the St Cyres Lecture in 1949 at the National Heart Hospital, London.10 With T. W. Peck, a pharmacist, he wrote a formal biography entitled “William Withering of Birmingham” published in 1950.11
Figure 6. Original frontispiece from Withering's “Account of the Foxglove” (1785).9
KD had a reputation as a keen observer and an astute diagnostician, working at a time when sophisticated diagnostic aids were largely lacking. He was an excellent bedside teacher, known affectionately to his students as “The Wilk”. Though he was often thought to be somewhat dogmatic, his generous nature and keen wit were appreciated, and he was a highly entertaining raconteur and mimic.
Social activities and hobbies
KD had many interests, and acquired a splendid collection of books and prints concerned with the history of Birmingham and its people. He was a man with many hobbies. Golf, photography, sailing, stamp collecting, and many other activities filled his leisure moments. He enjoyed bridge, played billiards with enthusiasm, loved cars, especially his prized Lagonda and later a Bentley, and kept bees.
He was an obsessive photographer. At meetings of the Cardiac Society, and of the British Paediatric Association, he was always strung about with cameras, looking as though he had “slept in his suit”. He would happily take pictures of anyone and everyone, both still pictures, taken with his much loved Leica, and cine films, acquired with a large and cumbersome Bell and Howell movie camera, many of which are now part of the archives of those societies.
In his paper on “John Hay and the Founders of the Cardiac Club”,2 Bramwell wrote “Kenneth Wilkinson was a character and very good company. When I stayed in his house, or he in mine, we never got to bed before midnight. A brilliant raconteur, with a fund of amusing stories which he told in various dialects, he could easily have made his living as a comedian on the music hall stage. He was a member of the British Paediatric Association as well as of the Cardiac Club, a general physician, and Professor of Pharmacology and Therapeutics. As a paediatric cardiologist, his chief interests were naturally rheumatic heart disease and diphtheritic myocarditis. In those days, congenital heart disease was still the province of the anatomist and, apart from Wardrop Griffith's communication at Leeds in 1934, one cannot recall more than casual reference to the subject at any meeting of the Club and, of course, Griffith was an anatomist. With his friend Whitmore Peck, Wilkinson wrote an excellent life of William Withering and, when the British Cardiac Society met in Birmingham in 1939, we dined under Withering's portrait, in the beautiful mansion which had been his house.
Wilkinson's hobbies were as varied as his clinical interests: he was a good golfer, a good bridge player, a yachtsman, a philatelist, and a bee-keeper. John Hay and Kenneth Wilkinson were the great photographers of the Club. At our meetings, Wilkinson was always hung about with cameras, exposure meters, and what not, like a Christmas tree. He had no great sartorial ambitions and sometimes looked as if he had gone to bed in his trousers. No meeting of the Club would have been complete without Wilkinson. We all loved him.”
KD was married in 1916, while on leave from war service in France. He had five children by his first wife, Phebe Homewood. His eldest surviving son, the first dying in infancy, became a general practitioner. His first wife died in 1940 and he re-married Agnes Crozier, a former house physician almost thirty years his junior. There were three further children by his second wife. His youngest son, by his second marriage, is also a paediatric cardiologist and the first author of this brief review of the career of the first British “paediatric cardiologist”. KD died of prostate cancer in April 1951, just one week short of his 65th birthday.
