Skip to main content

Willem Einthoven and the Birth of Clinical Electrocardiography a Hundred Years Ago

Cardiac Electrophysiology Review volume 7, pages 99–104 (2003)Cite this article

Abstract

The first electrocardiogram (ECG) from the intact human heart was recorded with a mercury capillary electrometer by Augustus Waller in May 1887 at St. Mary's Hospital, London. The tracings were poor and exhibited only 2 distorted deflections. Willem Einthoven (1860–1927) who was professor of physiology at the University of Leiden, The Netherlands, began his studies of the ECG with the mercury capillary electrometer, and improved its distortion mathematically so that he was finally able to register a good representation of the ECG before the beginning of the twentieth century. He later further improved ECG recordings with the introduction of a string galvanometer of his design. Einthoven published his first article about the string galvanometer in 1901, followed by a more detailed description in 1903 which included a report of ECGs taken with the new instrument. The year 2002 marks the centennial of Willem Einthoven's first recording of the ECG in a clinically applicable fashion with the string galvanometer. The clinical use of Einthoven's immobile equipment required transtelephonic transmission of the ECG from the physiology laboratory to the clinic at the Academic Hospital about a mile away as documented in the 1906 paper on the “télécardiogramme”. This report contained a wealth of ECG patterns and arrhythmias. Einthoven developed a system of electrocardiographic standardization that continues to be used all over the world and introduced the triaxial bipolar system with 3 limb leads and thus established uniformity of the recording process. Einthoven also conceived the famous equilateral triangle with leads I, II, and III at its sides and the calculation of the electrical axis (in the frontal plane) depicted as a single vector with an arrow at the center of the triangle. Einthoven recognized the great potential importance of the ECG as a diagnostic and investigative tool and his achievements made him the founder of modern electrocardiography. He was awarded the Nobel Prize in 1924 (2 years after Waller's death) in physiology and medicine, “for the discovery of the mechanism of the electrocardiogram.”

This is a preview of subscription content, access via your institution.

References

  1. Fisch C. Evolution of the clinical electrocardiogram. J Am Coll Cardiol 1989; 14: 1127-1138.

    Google Scholar 

  2. Fisch C. Centennial of the string galvanometer and the electrocardiogram. J Am Coll Cardiol 2000; 36: 1737-1745.

    Google Scholar 

  3. Acierno LJ. Graphic methods. In: Acierno LJ, ed. The History of Cardiology. New York: The Parthenon Publishing Group, 1994: 501-551.

    Google Scholar 

  4. Krikler DM. Electrocardiography then and now: Where next? Br Heart J 1987; 56: 84-491.

    Google Scholar 

  5. Krikler DM. The development of the understanding of arrhythmias during the last 100 years. Med Hist 1985; 5 (Suppl): 77-81.

    Google Scholar 

  6. Cooper JK. Electrocardiography 100 years ago. Origins, pioneers, and contributors. N Engl J Med 1986; 315: 461-464.

    Google Scholar 

  7. Katz LN, Hellerstein HK. Electrocardiography. In: Fishman AP, Richards DW, eds. Circulation of the Blood: Men and Ideas. Bethesda, MD: American Physiological Society, 1964: 265-347.

    Google Scholar 

  8. Burch GE, DePasquale NP. A History of Electrocardiography. Chicago IL: Year Book Publishers, 1964.

    Google Scholar 

  9. Davies MK, Hollman A. The electrocardiogram on stamps. Heart 1998; 79: 8.

    Google Scholar 

  10. Fye WB. A history of cardiac arrhythmias. In: Kastor JA, ed. Arrhythmias, Philadelphia: W. B. Saunders, 1994: 1-24.

    Google Scholar 

  11. Rautaharju PM. A hundred years of progress in electrocardiography 1: Early contributions fromWaller toWilson. Can J Cardiol 1987; 3: 362-374.

    Google Scholar 

  12. Fye WB. A history of the origin, evolution, and impact of electrocardiography. Am J Cardiol 1994; 73: 937-949.

    Google Scholar 

  13. Einthoven W. Galvanometrische registratie van het menschelijk electrocardiogram. In: Herinneringsbundel SS ed. Rosentein: Leiden Eduard Ijdo Leiden, 1902: 101-106.

    Google Scholar 

  14. Einthoven W. Die galvanometrische Registerung des menschlichen Elektrokardiogram: Zugleich eine Beurtheilung der Anwendung des Capillar-Elektrometers in der Physiologie. Pflügers Arch ges Physiol 1903; 99: 472-480.

    Google Scholar 

  15. Acierno LJ. Augustus Desire Waller. Clin Cardiol 2000; 23: 307-309.

    Google Scholar 

  16. Sykes AH. AD Waller and the electrocardiogram, 1887. Br Med J (Clin Res Ed) 1987; 294(6584): 1396-1398.

    Google Scholar 

  17. Burchell HB. A centennial note on Waller and the first human electrocardiogram. AmJ Cardiol 1987; 59: 979-983.

    Google Scholar 

  18. Besterman E, Creese R. Waller-Pioneer of electrocardiography. Br Heart J 1979; 42: 61-64.

    Google Scholar 

  19. Besterman E. Waller before Einthoven in the clinical development of noninvasive ECG. Am Heart J 1982; 103: 572.

    Google Scholar 

  20. Cope Z. Augustus Desire Waller (1856-1922).Med Hist 1973; 17: 380-385.

    Google Scholar 

  21. Waller AD. A demonstration on man of electromotive changes accompanying the heart's beat. J Physiol 1887; 8: 229-234.

    Google Scholar 

  22. Lippmann G. Biziehungen zwischen den capillaren und elektrischen Erscheinungen. Ann Phys Chem 1873; 149: 546-551.

    Google Scholar 

  23. Burchell HB. Did Einthoven invent a string galvanometer? Br Heart J 1987; 57: 190-193.

    Google Scholar 

  24. Silverman ME. Willem Einthoven-The father of electrocardiography. Clin Cardiol 1992; 15: 785-787.

    Google Scholar 

  25. Wiggers CJ. Willem Einthoven (1860-1927). Some facets of his life and work. Circulation Research1961; 9: 225-234.

    Google Scholar 

  26. Snellen HA. Willem Einthoven (1860-1927): Father of Electrocardiography. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1995.

    Google Scholar 

  27. De Waart A. Het Levenswerk von Willem Einthoven. Haarlem Holland: Ervin F. Bohn, 1957.

    Google Scholar 

  28. Ershler I. Willem Einthoven-The man. The string galvanometer electrocardiograph. Arch Intern Med 1988; 148: 453-455.

    Google Scholar 

  29. Kyle RA, Shapiro MA. Willem Einthoven. JAMA 1977; 237: 2108.

    Google Scholar 

  30. Shapiro E. Willem Einthoven's fortuitous invention. Am J Cardiol 1977; 40: 987-988.

    Google Scholar 

  31. Einthoven W. Uber die Form des menschlichen Electrocardiogramms. Pflügers Arch ges Physiol 1895; 60: 101-123.

    Google Scholar 

  32. Einthoven W, De Lint K. Über das normale menschliche Elektrocardiogramm und die capillärelektrometrische Untersuchung einiger Herzkranken. Pflügers Arch ges Physiol 1900; 80: 139-160.

    Google Scholar 

  33. Einthoven W. Un nouveau galvanomètre. Arch Néerl Sci Exactes Nat 1901; 6: 625-633.

    Google Scholar 

  34. Einthoven W. Le télécardiogramme. Arch Int Physiol 1906; 4: 132-164.

    Google Scholar 

  35. Einthoven W, Vaandrager B. Weiteres über das Elektrokardiogramm. Pflüegers Arch ges Physiol 1908; 122: 517-584.

    Google Scholar 

  36. Hurst JW. Naming of the waves in the ECG, with a brief account of their genesis. Circulation 1998; 98: 1937-1942.

    Google Scholar 

  37. Wyers PJ. The string in Einthoven's string galvanometer. Gewina 1996; 19: 80-94.

    Google Scholar 

  38. Xiao HB, Lawrence C. Reappraisal of Thomas Lewis's place in the history of electrocardiography. J Electrocardiol 1996; 29: 347-350.

    Google Scholar 

  39. Einthoven W. The different forms of the human electrocardiogram and their signification (Chelsea lecture). Lancet 1912; 1: 853-861.

    Google Scholar 

  40. Einthoven W, Fahr G, De Waart A. Über die Richtung und die manifeste Grössen der Potentialschwankungen im menschlichen Herzen und Über den Einfluss der Herzlage auf die Form des Elektrokardiogramms. PflÜgers Arch ges Physiol 1913; 150: 275-315.

    Google Scholar 

  41. Hollman A. Thomas Lewis-The early years. Br Heart J 1981; 46: 233-244.

    Google Scholar 

  42. Hollman A. Thomas Lewis: Physiologist, cardiologist, and clinical scientist. Clin Cardiol 1985; 8: 555-559.

    Google Scholar 

  43. Lewis T. Auricular fibrillation and its relationship to clinical irregularity of the Heart. Heart 1909; 1: 306-372.

    Google Scholar 

  44. Lewis T. Auricular fibrillation: A common clinical condition. Br Med J 1909; 2: 1528.

    Google Scholar 

  45. Kahn JK, Howell JD. Frank Norman Wilson. Clin Cardiol 1987; 10: 616-618.

    Google Scholar 

  46. Wilson FN, Johnston FD, Macleod AG, Barker PS. Electrocardiograms that represent the potential variations of a single electrode. Am Heart J 1934; 9: 447-458.

    Google Scholar 

  47. Wilson FN, Johnston FD, Rosenbaum F, Erlander H, Kossman C, Hecht H, Cotrim N, Menezes de Oliveira R, Scarci R, Barker P. The precordial electrocardiogram. Am Heart J 1944; 27: 19-85.

    Google Scholar 

  48. Kossmann CE. Unipolar electrocardiography of Wilson: A half century later. Am Heart J 1985; 110: 901-904.

    Google Scholar 

  49. Burch GE. History of precordial leads in electrocardiography. Eur J Cardiol 1978; 8: 207-236.

    Google Scholar 

  50. Burch GE, DePasquale NP. The period of the introduction of the precordial leads. In: Burch GE, DePasquale NP, eds. A History of Electrocardiography. Chicago IL: Year Book Publishers, 1964: 192-211.

    Google Scholar 

  51. Wellens HJJ. The electrocardiogram 80 years after Einthoven. J Am Coll Cardiol 1986; 7: 484-494.

    Google Scholar 

  52. Zipes DP. Clinical application of the electrocardiogram. J Am Coll Cardiol 2000; 36: 1746-1748.

    Google Scholar 

  53. Wiggers CJ. ti Principles and Practice of Electrocardiography. St. Louis: CV Mosby Co., 1929.

Download references

Author information

Affiliations

  1. Tampa General Hospital, Tampa, Florida, USA

    S. Serge Barold

Authors
  1. S. Serge Barold
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Barold, S.S. Willem Einthoven and the Birth of Clinical Electrocardiography a Hundred Years Ago. Card Electrophysiol Rev 7, 99–104 (2003). https://doi.org/10.1023/A:1023667812925

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1023667812925

  • Willem Einthoven
  • electrocardiography
  • history of electrocardiography
  • string galvanometer