Lives of the fellows

Ellis Jacob Epstein

b.29 December 1926 d.9 August 2013
MB ChB Manch(1950) MRCP(1956) MRCP Edin(1956) MD(1962) FRCP Edin(1971) FRCP(1973)

Ellis J Epstein was a consultant cardiologist at the regional cardiac centre in Liverpool. He was born in Salford, Lancashire, the son of Charles Epstein, a textile merchant, and Dora Epstein née Berman). He had an older sister, Evelyn, and a younger brother, Bernard. Ellis was educated locally and attended Salford Grammar School. He then went on to Manchester University to study medicine, qualifying in 1950.

After house posts at Manchester Royal Infirmary, he joined the Royal Navy for his National Service, working as a surgeon lieutenant. He left in 1953 and Ellis continued his general medical training at the Royal Devon and Exeter Hospital and Manchester Royal Infirmary. He then gained medical registrar posts at Withington Hospital, South Manchester and the London Chest Hospital. He achieved his membership of the Royal College of Physicians of London and of Edinburgh in 1956.

In 1959 Ellis became a senior registrar in cardiology at the Liverpool regional cardiac centre at Sefton General Hospital, where his career in cardiology really began. In 1962 he went to Victor McKusick’s [Munk’s Roll, Vol.XII, web] unit at Johns Hopkins University School of Medicine, Baltimore. Here he worked with J Michael Criley, an expert on cardiac haemodynamics and cardiac auscultation, at a time when cineangiography was becoming an important technique for studying and diagnosing cardiac disease.

In 1962 Ellis was awarded his MD from Manchester University. His thesis on aortic stenosis correlated the symptoms, physical signs, chest X-ray and ECG findings with those from carotid pulse wave morphology, apex cardiography, phonocardiography and ultimately cardiac catheterisation, with the aim of finding a reliable, non-invasive assessment of the severity of the disease. His techniques would be used to help decide which patients should be put forward for aortic valve surgery at a time before echocardiography was available.

In 1964 Ellis was appointed as a consultant cardiologist at the regional cardiac centre at Sefton General Hospital, Liverpool. The centre provided a specialised approach to the diagnosis and treatment of patients with a wide range of cardiac diseases, in particular rheumatic heart disease, which was particularly prevalent in Merseyside in the 1950s and 1960s. The accurate diagnosis of valvular heart disease was key to supporting the thoracic surgeons, who were developing the surgical treatment of closed mitral valvotomy and subsequently mitral and aortic valve replacement, which had begun at Mossley Hill Hospital. His focus was not only on developing the non-invasive diagnostic techniques of phono- and apex cardiography, but also the invasive cardiac catheterisation laboratory, using his skills in left ventricular and coronary angiography, as well as right and left heart catheterisation, transseptal puncture and direct left ventricular puncture. Over many years, Ellis patiently taught these techniques to his trainees, most of whom went on to consultant practice in cardiac centres all around the world. Ellis also reported the technique of transseptal puncture from the right subclavian vein.

Ellis’ research involved the use of phonocardiography and apex cardiography – techniques which he developed extensively using specially designed crystal microphones and funnel-shaped pick-ups placed carefully on the chest wall and over the carotid artery, and using a multichannel oscilloscope recorder and a paper speed of 100mm/sec. Measurements were taken meticulously with the patient in various positions and phase of respiration whilst using a unipolar ECG lead at the site of the apex cardiogram. By measuring the total period of electromechanical systole, the left ventricular ejection time, the interval from the beginning of the upstroke of the apex cardiogram to the onset of the carotid upstroke and the pulse transmission time, intervals such as the pre-ejection period, isovolumetric contraction time and the period of total mechanical systole could be calculated. These important studies provided a non-invasive means of measuring cardiac performance in normal subjects and in patients with myocardial infarction.

His mastery of these non-invasive skills led to a clearer understanding of the origin of the systolic click in aortic stenosis, of the mid-systolic click/late systolic murmur syndrome (Barlow’s syndrome), the mechanism of acute mitral regurgitation resulting from ruptured or elongated chordae tendineae, and the origin of additional heart sounds after prosthetic valve implantation in normal and abnormal functional states. His papers are beautifully illustrated and even today are worth a look.

Ellis was a firm believer that skilful auscultation with a stethoscope was a most rewarding bedside tool. He taught at the bedside, showing students the art of history taking and physical examination, and in particular the careful scrutinisation of the cardiovascular system by observation, palpation and purposeful auscultation. Many of the medical students and junior doctors in training who passed through the regional cardiac unit in Liverpool were fortunate to receive his wonderful tuition.

His book Cardiac auscultation (Butterworth-Heinemann, 1991) is a ‘must read’ for all those planning a career in cardiology. His other publications included papers on cineradiographic studies of sound production by diseased and prosthetic aortic valves, the haemodynamic effects of severe aortic regurgitation, the occurrence of bacterial endocarditis in idiopathic hypertrophic subaortic stenosis, the phenomenon of coronary embolism in valvular heart disease, and the description of constrictive pericarditis after myocardial infarction.

When I began PTCA (percutaneous transluminal coronary angioplasty) in Liverpool in 1983, Ellis was very supportive in helping me and Alex Harley develop a service at a time when the regional health authority was very much against funding such ‘new procedures’. I can remember his excitement in 1985 when he saw me open up an occluded right coronary artery in a patient with an acute inferior myocardial infarction. He surely recognised the potential of coronary angioplasty at a time when the only alternative to medical treatment of angina pectoris was coronary artery bypass surgery. He would have been extremely interested in today’s interventional cardiology.

He gained his fellowship of the Royal College of Physicians of Edinburgh in 1971 and of London in 1973. He retired from full-time clinical practice in 1991, but continued to teach medical students and junior doctors at the bedside at the Liverpool Heart and Chest Hospital until only a short time before his death.

Ellis loved, lived and breathed cardiology and read little else except books and papers on the subject. Being in the Navy probably explains his interest in Admiral Nelson and he enjoyed bridge, jazz and the music of Tina Turner! In his younger days he was an accomplished skier and enjoyed gliding, sailing, scuba diving and driving his Triumph TR4 sports car. When the weather was good he jogged around Calderstones Park and, when it was wet, he rode on his exercise bike and read a cardiology journal!

Ellis married Gwen (née Collins) in 1968 and they had three children – Andrew, Victoria and Suzanne. Andrew went on to become a consultant cardiologist.

Ellis was an enthusiast as far as cardiology was concerned, who practised conscientiously with great care and skill. He was loved by his patients, by the staff who worked with him, and, of course, by his family. Many of us remain grateful to him for what he taught us, for helping to establish the specialist cardiac centre at Liverpool and for his exemplary honesty, patience and loyalty.

David R Ramsdale

[Brit.med.J.2013 347 5948]

(Volume XII, page web)

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