A view from the millennium: the practice of cardiology circa 1950 and thereafter

The knowledge and treatment of cardiology as practiced circa 1950 is discussed as abstracted from authoritative textbooks of that time and other sources. Advances in treatment and diagnostic techniques since 1950 are presented. Dramatic changes in cardiology have come at the expense of bedside cardiology which needs to be balanced with the technology.

To Wenckebach: a centenary salute

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The zero of potential

It is convenient to select a reference point for recording ECG potentials on the torso or EEG potentials on the scalp. The body is a bounded, insulated volume conductor. As such, it is meaningless to seek a point whose potential is at true zero. The choice of a particular reference, and hence the amplitude assigned to a contour, does not change in any way the biophysical information contained in the potential distribution. It does not in any way change the relation between source and potential, except for an additive constant of no physical significance. Standardization of a reference is useful for comparing, more directly, data from different laboratories. An agreed upon reference is necessary when a limited number of leads are used for diagnosis. In the case of the electrocardiogram, the generally agreed upon reference is the WCT. The issue of the zero of potential seems to arouse passions that may sometimes inhibit scientific discourse.

[From the history of electrocardiography]

The basis of electrocardiography was established in the innovative years between 1850 and 1930. Men like Waller, DuBois-Reymond, and Einthoven were the innovators of what we today recognize as modern electrocardiography. Others, like Lewis and Bedford, introduced analysis of cardiac arrhythmias, of the S-T segment and the QRS complex. The article gives an overview of this innovative period and its instrumentation.

Historical evolution of circuit models for the electrode-electrolyte interface

Electrodes are widely used to measure bioelectric events and to stimulate excitable tissues. In one form or another, electrodes have been around for nearly two centuries; yet our ability to predict their properties is extremely limited, despite considerable research, especially during the last century. This paper chronicles the accumulation of knowledge about the electrode-electrolyte interface as a circuit element. Our understanding of this interface starts with the Helmholtz double layer of charge and progresses through the Warburg and Fricke low-current-density models, which demonstrated that the resistive and capacitive components are polarization elements, the values of which depend on frequency. The discovery by Schwan, showing that the components of the Warburg-Fricke model are current-density dependent, is recounted, along with the discovery of the rectifying properties of the electrode-electrolyte interface and how it was put to practical use. The very high current-density operation of the interface is discussed in terms of gas evolution, arching, and shock-wave production. Finally the evolution of recording electrodes is traced. Because electrodes can be operated over a very wide range of current density, it is unlikely that a single model can be created for the electrode-electrolyte interface, although over a restricted current-density range such a model may be possible.

Sir Thomas Lewis (1881-1945)

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Reappraisal of Thomas Lewis's place in the history of electrocardiography

Thomas Lewis is among the most significant figures in the history of electrocardiography. In the late 1920s, he abandoned electrocardiography for other areas that he considered to be clinical science, in spite of the fact that he had made great contributions to the then new technique and that interest in this technique was increasing worldwide. The reasons why Lewis left electrocardiography are discussed further here. Lewis's leaving of electrocardiography had as much influence on the history of electrocardiography as did his practice of it.

[Discovery of the pacemaker and heart conduction system in mammals. Fantasy and truth]

The first report about experimental investigations on the origin of the rhythms in the mammalian heart were published in 1888 by McWilliam. Similar experiments were described by Hering in several publications starting from 1900. The results led to the hypothesis of the myogenic genesis of the rhythms. However, in 1907, Hering stated that the origin of the stimulus in the mammal heart was probably a nervous function. In 1898, 1903, and 1906 Wenckebach described the function and the functional localization of the pacemaker in the heart of the intact man, and in 1906, he described the morphology of the pacemaker and its blood supply in the post mortem human heart. In the same year, Adam analyzed the localization of the "natural" pacemaker and the regions of the secondary pacemakers in the mammal heart. In 1907, Keith and Flack introduced the term "sino-auricular node". They quoted the findings of Wenckebach and Hering, and they mentioned McWilliam. A muscular connection between the right atrium and both ventricles of the mammal heart was found by Kent and by His in 1893. In 1907, Tawara called the structure of the origin of the a-v connection "atrio-ventricular node". It was, however, the scientific discovery of Tawara that the a-v pathway was connected with the muscles of the ventricles by the Purkinje fibers. He discovered that the pathway consists of muscles which are histologically divided and functionally different from the other heart muscles. It is a system of specialized muscles which conduct the stimulus for the contraction without contracting themselves.