James Alexander Lindsay (1856-1931), and his clinical axioms and aphorisms

Abstract

John Alexander Lindsay was born at Fintona, county Tyrone in 1856, and at the age of 23 he graduated in medicine at the Royal University of Ireland. After two years in London and Europe he returned to Belfast to join the staff at the Royal Victoria Hospital and in 1899 he was appointed to the professorship of medicine. He was valued by the students for his clarity and by his colleagues for his many extracurricular contributions to the medical profession in the positions entrusted to him. He published monographs on Diseases of the Lungs, and the Climatic Treatment of Consumption, but his later Medical Axioms show his deep appreciation of studied clinical observation. Although practice was changing in the new century Lindsay displayed an ability to change with the new requirements, as evidenced by his lecture on electrocardiography as president of the section of medicine of the Royal Academy of Medicine in Ireland in 1915. He was impressed by the way the string galvanometer changed attention from stenosis and incompetence of the valves to the cardiac musculature, but rightly suspected that there was more to be told about the state of the myocardium than Einthoven's three leads revealed. His death occurred in Belfast in 1931.

Fig 1

James Alexander Lindsay

Fig 2

Leads I, II and III recorded by the string galvanometer. Spread of electrical excitation into ventricular muscle generates the QRS complex. Left ventricular preponderance is indicated by high R in Lead 1 and deep S in Lead III.

Figure 3

Mitral stenosis eases the load on the left ventricle and increases the work of the right ventricle. A deep S in Lead I and a high R in Lead III typify right ventricular hypertrophy.