ECG Library

A brief history of electrocardiography.

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
German physiologist Emil Dubois-Reymond describes an "action potential" accompanying each muscular contraction and confirms Matteucci's findings in frogs.
Rudolph von Koelliker and Heinrich Muller record an action potential.
Alexander Muirhead of St Bartholomew's Hospital, London may have a recorded a human electrocardiogram but this is disputed.
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.
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
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
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
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
Dutch physiologist Willem Einthoven sees Waller demonstrate his technique at the First International Congress of Physiologists.
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
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
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
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
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
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
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
Einthoven discusses commercial production of a string galvanometer with Max Edelmann of Munich and Horace Darwin of Cambridge Scientific Intstruments Company of London.
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.
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)
Edward Schafer of the University of Edinburgh is the first to buy a string galvanometer for clinical use.
Thomas Lewis of University College Hospital, London buys one and so does Alfred Cohn of Mt Sinae Hospital, New York.
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
Thomas Lewis publishes a classic textbook. The mechanism of the heart beat. London: Shaw & Sons and dedicates it to Willem Einthoven.
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-
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
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
Willem Einthoven wins the Nobel prize for inventing the electrocardiograph.
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
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.
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
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
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.


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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.