Thomas Lewis--the early years

History of the British Cardiovascular Society

In 2022, the British Cardiovascular Society celebrates the centenary of its foundation. Starting out as a small group of government-appointed physicians interested in heart disease, the Cardiac Club has grown and adapted to represent all those working in cardiovascular care and research. The historical stages of the organisation's development are outlined, alongside major innovations in science and technology providing context for a rapidly changing medical world. Only a small part of the history of cardiology in Britain is told, with greater emphasis on describing the broader need for services, skilled workforce, healthcare policy and continuing education. Above all, the history of the British Cardiovascular Society is a story of people and places. The people are those with vision, attitude and leadership to improve the care of communities across the world. The places are those that enabled conversation, innovation and freedom to bring about change. It is hard to believe the remarkable progress in diagnosis, prevention and treatment of heart disease over 100 years, but a thriving modern Society must be the greatest legacy of its founders.

The ladder diagram (a 100+ year history)

The ladder diagram (also called a laddergram) remains a popular visual aid when graphically representing the mechanism of arrhythmia. It disentangles atrial and ventricular electrical activity and gives explicit representation to the sinoatrial and atrioventricular nodes. More than 100 years after the first published ladder diagrams, this report reviews their origins, development, and limitations. Ladderlike diagrams have existed since 1885, first applied to venous and arterial pulsation timing or waveform tracings and later in 1920 alongside electrocardiograms to explain the generation and propagation of electrical impulses in the heart. Two examples are presented in which the underlying mechanism of arrhythmia either was predicted by a ladder diagram and later confirmed by intracardiac recordings (atrioventricular nodal reentrant tachycardia) or underwent evolution of its ladder diagram depiction as the pathophysiology became better understood (atrial flutter). In general, the ladder diagram represents well abnormalities of impulse conduction but is less explicit with abnormalities of impulse formation. In conclusion, the surprising scarcity of major changes since the introduction of the ladder diagram testifies to its power to deal with a range of arrhythmogenic mechanisms that were unknown at the time of its development.

From rebellious palpitations to the discovery of auricular fibrillation: contributions of Mackenzie, Lewis and Einthoven

An irregular pulse, referred to as rebellious palpitations, delirium cordis and pulsus irregularis perpetuus, was a cause of speculation by physicians since early times. It was James Mackenzie, a Scottish general practitioner in Burnley, England, utilizing an ink-writing polygraph to record and label jugular venous pulses, who would pioneer in deciphering normal and abnormal cardiac rhythms. His key observation that the jugular "A wave" was lost in a patient who went from a normal to an irregular rhythm provided the first insight into the mechanism of auricular fibrillation. Similar jugular venous and arterial pulse findings were discovered by Cushny, Edmunds and Lewis in directly observed experimental auricular fibrillation. In 1909 Lewis in England and Rothberger and Winterberg in Vienna, taking advantage of Einthoven's newly developed string galvanometer, were the first to establish electrocardiographically that auricular fibrillation was the cause of pulsus irregularis perpetuus.

A title lost, but a reputation won

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"Soldier's heart": the redefinition of heart disease and specialty formation in early twentieth-century Great Britain

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