A Brief History of Electrocardiography
ECG Library
A brief history of electrocardiography.
----------------------------------------------------------------------------
1842 Italian physicist Carlo Matteucci shows that an electric current
accompanies each heart beat. Matteucci C. Sur un phenomene
physiologique produit par les muscles en contraction. Ann Chim Phys
1842;6:339-341
1843 German physiologist Emil Dubois-Reymond describes an "action potential"
accompanying each muscular contraction and confirms Matteucci's
findings in frogs.
1856 Rudolph von Koelliker and Heinrich Muller record an action potential.
1869-70
Alexander Muirhead of St Bartholomew's Hospital, London may have a
recorded a human electrocardiogram but this is disputed.
1872 French physicist Gabriel Lippmann invents a capillary electrometer. It
is a thin glass tube with a column of mercury beneath sulphuric acid.
The mercury meniscus moves with varying electrical potential and is
observed through a microscope.
1876 Marey uses the electrometer to record the electrical activity of an
exposed frog's heart. Marey EJ. Des variations electriques des muscles
et du couer en particulier etudies au moyen de l'electrometre de M
Lippman. Compres Rendus Hebdomadaires des Seances de l'Acadamie des
sciences 1876;82:975-977
1878 British physiologists John Burden Sanderson and Frederick Page record
the heart's electrical current with a capillary electrometer and shows
it consists of two phases (later called QRS and T). Burdon Sanderson J.
Experimental results relating to the rhythmical and excitatory motions
of the ventricle of the frog. Proc R Soc Lond 1878;27:410-414
1884 John Burden Sanderson and Frederick Page publish some of their
recordings. Burdon Sanderson J, Page FJM. On the electrical phenomena
of the excitatory process in the heart of the tortoise, as investigated
photographically. J Physiol (London) 1884;4:327-338
1887 British physiologist Augustus D. Waller of St Mary's Medical School,
London publishes the first human electrocardiogram. It is recorded from
Thomas Goswell, a technician in the laboratory. Waller AD. A
demonstration on man of electromotive changes accompanying the heart's
beat. J Physiol (London) 1887;8:229-234
1889 Dutch physiologist Willem Einthoven sees Waller demonstrate his
technique at the First International Congress of Physiologists.
1890 GJ Burch of Oxford devises an arithmetical correction for the observed
(sluggish) fluctuations of the electrometer. This allows the true
electrocardiogram waveform to be seen but only after tedious
calculations. Burch GJ. On a method of determining the value of rapid
variations of a difference potential by means of a capillary
electrometer. Proc R Soc Lond (Biol) 1890;48:89-93
1891 British physiologists William Bayliss and Edward Starling of University
College London improve the capillary electrometer. They connect the
terminals to the right hand and to the skin over the apex beat and show
a "triphasic variation accompanying (or rather preceding) each beat of
the heart". These deflections are later called P, QRS and T. Bayliss
WM, Starling EH. On the electrical variations of the heart in man. Proc
Phys Soc (14th November) in J Physiol (London) 1891;13 and also On the
electromotive phenomena of the mammalian heart. Proc R Soc Lond
1892;50:211-214 They also demonstrate a delay of about 0.13 seconds
between atrial stimulation and ventricular depolarisation (later called
PR interval). On the electromotive phenomena of the mammalian heart.
Proc Phys Soc (21st March) in J Physiol (London) 1891;12:xx-xxi
1893 Willem Einthoven introduces the term 'electrocardiogram' at a meeting
of the Dutch Medical Association. (Later he claims that Waller was
first to use the term). Einthoven W: Nieuwe methoden voor clinisch
onderzoek [New methods for clinical investigation]. Ned T Geneesk 29
II: 263-286, 1893
1895 Einthoven, using an improved electrometer and a correction formula
developed independently of Burch, distinguishes five deflections which
he names P, Q, R, S and T. Einthoven W. Ueber die Form des menschlichen
Electrocardiogramms. Arch f d Ges Physiol 1895;60:101-123
1897 Clement Ader, a French electrical engineer, reports his amplification
system called a string galvanometer which is used for undersea
telegraph lines. Ader C. Sur un nouvel appareil enregistreur pour
cables sous-marins. C R Acad Sci (Paris) 1897;124:1440-1442
1901 Einthoven modifies a string galvanometer for producing
electrocardiograms. His string galvanometer weighs 600 pounds.
Einthoven W. Un nouveau galvanometre. Arch Neerl Sc Ex Nat
1901;6:625-633
1902 Einthoven publishes the first electrocardiogram recorded on a string
galvanometer. Einthoven W. Galvanometrische registratie van het
menschilijk electrocardiogram. In: Herinneringsbundel Professor S. S.
Rosenstein. Leiden: Eduard Ijdo, 1902:101-107
1903 Einthoven discusses commercial production of a string galvanometer with
Max Edelmann of Munich and Horace Darwin of Cambridge Scientific
Intstruments Company of London.
1905 Einthoven starts transmitting electrocardiograms from the hospital to
his laboratory 1.5 km away via telephone cable. On March 22nd the first
'telecardiogram' is recorded from a healthy and vigorous man and the
tall R waves are attributed to his cycling from laboratory to hospital
for the recording.
1906 Einthoven publishes the first organised presentation of normal and
abnormal electrocardiograms recorded with a string galvanometer. Left
and right ventricular hypertrophy, left and right atrial hypertrophy,
the U wave (for the first time), notching of the QRS, ventricular
premature beats, ventricular bigeminy, atrial flutter and complete
heart block are all described. Einthoven W. Le telecardiogramme. Arch
Int de Physiol 1906;4:132-164 (translated into English. Am Heart J
1957;53:602-615)
1908 Edward Schafer of the University of Edinburgh is the first to buy a
string galvanometer for clinical use.
1909 Thomas Lewis of University College Hospital, London buys one and so
does Alfred Cohn of Mt Sinae Hospital, New York.
1910 Walter James, Columbia University and Horatio Williams, Cornell
University Medical College, New York publish the first American review
of electrocardiography. It describes ventricular hypertrophy, atrial
and ventricular ectopics, atrial fibrillation and ventricular
fibrillation. The recordings were sent from the wards to the
electrocardiogram room by a system of cables. There is a great picture
of a patient having an electrocardiogram recorded with the caption "The
electrodes in use".James WB, Williams HB. The electrocardiogram in
clinical medicine. Am J Med Sci 1910;140:408-421, 644-669
1911 Thomas Lewis publishes a classic textbook. The mechanism of the heart
beat. London: Shaw & Sons and dedicates it to Willem Einthoven.
1912 Einthoven addresses the Chelsea Clinical Society in London and
describes an equilateral triangle formed by his standard leads I, II
and III later called 'Einthoven's triangle'. This is the first
reference in an English article I have seen to the abbreviation
'EKG'.Einthoven W. The different forms of the human electrocardiogram
and their signification. Lancet 1912(1):853-
1920 Hubert Mann of the Cardiographic Laboratory, Mount Sinae Hospital,
describes the derivation of a 'monocardiogram' later to be called
'vectorcardiogram'. Mann H. A method of analyzing the
electrocardiogram. Arch Int Med 1920;25:283-294
1920 Harold Pardee, New York, publishes the first electrocardiogram of an
acute myocardial infarction in a human and describes the T wave as
being tall and "starts from a point well up on the descent of the R
wave". Pardee HEB. An electrocardiographic sign of coronary artery
obstruction. Arch Int Med 1920;26:244-257
1924 Willem Einthoven wins the Nobel prize for inventing the
electrocardiograph.
1928 Ernstine and Levine report the use of vacuum-tubes to amplify the
electrocardiogram instead of the mechanical amplification of the string
galvanometer. Ernstine AC, Levine SA. A comparison of records taken
with the Einthoven string galvanomter and the amplifier-type
electrocardiograph. Am Heart J 1928;4:725-731
1928 Frank Sanborn's company (later acquired by Hewlett-Packard) converts
their table model electrocardiogram machine into their first portable
version weighing 50 pounds and powered by a 6-volt automobile battery.
1932 Charles Wolferth and Francis Wood describe the clinical use of chest
leads. Wolferth CC, Wood FC. The electrocardiographic diagnosis of
coronary occlusion by the use of chest leads. Am J Med Sci
1932;183:30-35
1938 American Heart Association and the Cardiac Society of Great Britain
define the standard positions, and wiring, of the chest leads V1 - V6.
The 'V' stands for voltage. Barnes AR, Pardee HEB, White PD. et al.
Standardization of precordial leads. Am Heart J 1938;15:235-239
1942 Emanuel Goldberger adds the augmented limb leads aVR, aVL and aVF to
Einthoven's three limb leads and the six chest leads making the 12-lead
electrocardiogram that is used today.
----------------------------------------------------------------------------
Sources
* Fye WB. A history of the origin, evolution, and impact of
electrocardiography. Am J Cardiol 1994;73:937-949
* Burchell HB. A centennial note on Waller and the first human
electrocardiogram. Am J Cardiol 1987;59:979-983
* Burnett J. The origins of the electrocardiograph as a clinical
instrument. Medical History Supplement 5: 1985, 53-76. Published as a
monograph. The emergence of modern cardiology. Bynum WF, Lawrence C,
Nutton V, eds. Wellcome Institute for the History of Medicine:1985.
* Hewlett-Packard - 'History and Mission'
Comments, corrections or additions are very welcome.
----------------------------------------------------------------------------
Number of visitors since 19th December 1996 = [Image]
----------------------------------------------------------------------------
This page was first written on 4th December 1996, last updated 26th January
1997 and the links were working when I last tried them. From here you can go
back to the ECG library contents, go to my homepage, go to the MRCP part 1
question bank, go to a list of medical links or email me, Dean Jenkins.
