Frederick Percival Mackie
Colonel Frederick Percival Mackie was an English physician who served in the Indian Medical Service between 1901 and 1931 working on the incidence, transmission, and pathology of insect-borne tropical diseases. He discovered the vectors for relapsing fever and kala-azar. He had important administrative responsibilities in Iraq during the First World War and emerged as a leading figure in Indian medical science, public health, and tropical hygiene between the wars as director of the Haffkine Institute in Bombay.
Personal life and career
Born on 19 February 1875 to Annis, née Bennett, and John Mackie, rector of Filton, Gloucestershire, England, Frederick Percival was the second of their four surviving children. At the time of his marriage to Annis, John already had seven children by a previous marriage, and it fell to Annis to become, with the addition of her own four, mother or stepmother to eleven children. She was a devoted parent, kept closely in touch with them, and chronicled their doings almost until the time of her death in 1927. Her family chronicles provided much of the material included in a memoir by one of her grandchildren, which contains a more detailed account of Percival Mackie's early years, his boyhood adventures and schooling, his academic successes, the women he married, his character, and career highlights as seen from her maternal perspective.Medical training
Mackie showed an early interest in anatomy. Family legend has it that when the family dog died, he boiled it up in a huge cauldron on the vicarage lawn until the bones came loose so that he could take them out and dry them and reassemble the dog as a skeleton. He received his early education at Dean Close School, Cheltenham, and his basic medical training at the University of Bristol Medical School and St Bartholomew's Hospital. London. His exceptional ability was quickly recognized. As Saunders scholar and silver medallist at Bristol General Hospital, he completed his final exams in 1898 and was immediately appointed to a position as Casualty Officer and House Physician. During this time, in December 1898, he published his first of some 85 scientific papers, "Notes on a Case of Blackwater Fever" in The Lancet. A year later he was Junior Medical Officer at County Medical Asylum in Shrewsbury, and then spent 18 months as Superintendent at the Bristol City Isolation Hospital at Ham Green. He entered the Indian Medical Service, passing out in first place in 1902, aged 27, with a gold medal in medicine. Later in his career he added the F.R.C.P and the F.R.C.S as well as the D.P.H to his professional qualifications.1903–1914 research on tropical diseases
Soon after his arrival in India in 1903, Mackie joined the Younghusband Expedition to Tibet as medical officer, with the military rank of Lieutenant, attached to the 38th Central India Horse Regiment. On his return, he became assistant director of the Plague Research Laboratory in Bombay and began working on plague, a topic to which he returned some 20 years later. In 1905, W.B. Bannerman, the director of the laboratory, wrote that, "Capt. Mackie has served under me for the past 6 months. He has good intelligence, ability and self-reliance and is very pleasant to work with. His professional efficiency is of a high order and he is tactful in his dealings with his subordinates. He is zealous and diligent in the discharge of his professional duties and his conduct is excellent." Throughout his life, so far as his administrative duties permitted, Mackie devoted himself to the study of plague and other tropical disease. As he later put it in his presidential address to the Medical Research Section of the Indian Science Congress "For nearly twenty years my principal interest has been in the relationship of insects to the transmission of disease, having devoted successive periods of time to fleas and plague, bugs and lice and relapsing fever, mosquitoes and malaria, tse-tse flies and sleeping sickness, and to the insect side of the kala-azar problem."Relapsing fever
While at the Plague Research Laboratory he made what was probably his chief contribution to medicine, the discovery that the body louse, a blood-sucking insect, might serve as a vector for the transmission of relapsing fever. In August 1907 Mackie was sent to investigate an outbreak of relapsing fever that had broken out at a mission settlement in Nasik, in the state of Maharashtra. The boys and girls residing at the settlement were housed in separate, similar bungalows but many more of the boys than the girls were taken ill with the disease and Mackie's investigation pointed to the cause. The boys were found to be infested with body lice, while the girls were almost free of them. Confirmation of the body louse as vector came from microscopic examination of the lice, which showed they were carrying large numbers of the spirochetes characterizing the human disease and that they were multiplying within the insects' stomachs. It was subsequently found that transmission occurs when the louse is crushed against the victim's skin.Royal Society Sleeping Sickness Commission
A pressing issue at the time was the possibility of African sleeping sickness spreading to India via similar blood-sucking insect vectors. In September 1908, at the request of the Indian Government, Captain Mackie was attached to the Royal Society's Sleeping Sickness Commission headed by Sir David Bruce F.R.S. Based at Mpumo, Uganda. Mackie was one of Bruce's youthful "Three Musketeers," the others being Captains H.R. Bateman and Albert Ernest Hamerton. The accompanying photo shows Mackie, Lady Bruce, Bruce, Bateman and Hamerton at their lab in Uganda, 1908. The work in Africa represented a huge step forward in the understanding of trypanosome-related diseases not only in humans but in domestic cattle and wild animals, including elephants. Some 17 publications arose from this work in which Mackie was a co-author. Of the many species of Trypanosoma studied only T. gambiense causes sleeping sickness in humans. The disease is spread by blood sucking insects of the genus Glossina, which include tse-tse flies. The researchers studied the length of time tse-tse flies retained the parasite, how long it took to mature, how long the flies remained capable of transmitting the infection, what proportion of flies were infected, how many were required to cause sickness, whether transmission could occur "mechanically" by surface contact of the fly's mouthparts, and many other aspects. In a critical series of experiments it was found that the flies remained infective for up to 75 days after becoming infected themselves and that a tiny drop of fluid taken from the gut of the 75-day-old fly injected under the skin of a monkey gave rise to sleeping sickness after an incubation period of eight days. The commission's work served to reassure the Indian government that there was no risk of sleeping sickness spreading to India as it was clear that only Glossina could carry the infection and no species of this genus were native to India.Kala-Azar
Mackie was recalled to India in 1909 and appointed Special Research Officer for the investigation of kala-azar. In 1914 he studied cases of kala-azar in Nowgong, Assam, where there were many cases of the disease among the local population. He noted that anopheline mosquitoes were rare, but species of Culex and Phlebotomus were common. Examination of 273 patients showed an abundance of LD bodies in the blood and in splenic biopsies. Mackie captured insects on fly papers and examined them for stages of the parasite. He found flagellated forms of the parasite in sand flies of the genus Phlebotomus. The topographical distribution of kala-azar closely matched the distribution of the sand flies. This pointed to sand flies as the blood-sucking insects that serve as vectors for the disease. Other workers were engaged in similar investigations elsewhere in India, and it was unclear who had priority, but it was eventually accepted that "F.P. Mackie was probably the first to note this association. The only insect which has given any return for the work put into it is the sandfly."War service in Mesopotamia
At the outbreak of war in 1914, Mackie returned to active military service in Baluchistan, Persia, Mesopotamia, and France. We know most about his time in Mesopotamia from a series of laboratory records and articles he himself wrote for newspapers.Late in 1915, the British campaign to end Ottoman control of Mesopotamia was focussed on relief of the besieged British forces at Kut, where the British 6th Army Division was engaging Turkish forces, with heavy casualties on both sides. Mackie brought a fully equipped laboratory from France to Basra. From there he was directed to proceed to Amara where there were thousands of British and Indian military personnel in hospitals, few of which had adequate pathology backup. Rather than equipping every hospital with fully equipped testing laboratories, the British established central laboratories, first in Amara and, after it was liberated, Baghdad. The larger hospitals were gradually provided with the necessary materials and trained staff to become more self-sufficient. Furthermore, mobile units were established which could be rapidly despatched to areas experiencing sudden disease outbreaks.
Mackie, now Major, was Commanding Officer of the Central Bacteriological Laboratory in Amara from 1916 to 1918, when he took charge of the much larger one in Baghdad, with supervisory responsibilities over all clinical testing units in the city along with those concerned with water quality testing and veterinary pathology.
The principle diseases encountered were enteric fever and dysentery, both bacterial and amoeboid. There were several outbreaks of cholera, in one of which General Sir Stanley Maude succumbed. Malaria was also prevalent and there were villages where "practically every child was diseased." Plague epidemics had to be dealt with in all the major cities.
In a 1919 address, Mackie emphasized the importance of close cooperation between pathologists in their labs and physicians on the hospital floor. At the same time, on the basis of his observations in India and Mesopotamia, he stressed that while much of the work in pathology labs was routine, the pathologist's "greatest work is to discover the beginnings of disease and to study the underlying processes..."
Mackie was twice mentioned in dispatches for his war work and the award of O.B.E. was conferred upon him on 3 June 1918.