The Development of the Electrocardiogram, 1887-1954

Nineteenth-century physiology had already made bodily events into curves. Carl Ludwig's kymograph registered movement against time, while electrical instruments developed for physics, telegraphy, and power engineering offered ways to detect small currents. Experiments on animal hearts preceded human recording. The ECG therefore grew from an international traffic in techniques, not from cardiology acting alone (Burnett).

At St Mary's Hospital in London, Augustus Desiré Waller used Gabriel Lippmann's capillary electrometer, in which electrical potential altered the boundary between mercury and an electrolyte. In October 1887 the Journal of Physiology published his demonstration of electrical changes accompanying the human heartbeat. The capillary's inertia distorted fast changes, and the photographic procedure was awkward, but the experiment established that a signal could be obtained non-invasively from the intact body (Waller).

“First ECG” requires qualification. A later family biography credited the telegraph engineer Alexander Muirhead with a human recording at St Bartholomew's Hospital around 1869-1870. No contemporaneously published trace accompanies that retrospective claim in the sources used here. Waller's 1887 article is the secure published landmark; it should not be turned into proof that no earlier experiment occurred (Burnett).

1. 1856-1887: animal electrophysiology, capillary electrometry, graphic recording, and telegraphic instruments supply the concepts and components from which human electrocardiography develops (Burnett).
2. October 1887: Waller publishes a human surface recording made with the capillary electrometer at St Mary's Hospital. His paper is a physiological demonstration, not a claim that the trace can already diagnose a catalogue of diseases (Waller).
3. 1895: at Leiden, Einthoven publishes a mathematical correction for the distorted capillary trace and labels five reconstructed deflections P, Q, R, S, and T. The reason for choosing those particular letters remains uncertain; later explanations are hypotheses, not Einthoven's documented account (Hurst).
4. 1901-1903: Einthoven gives a preliminary description of his string galvanometer in 1901 and a fuller account in 1903. A silver-coated quartz filament moving in a magnetic field responded quickly enough for a much more faithful recording, but the Leiden apparatus was still an experimental installation rather than a convenient bedside machine (Burnett).
5. 1905-1906: because the apparatus could not easily be moved to sick patients, Leiden University Hospital was connected by roughly one mile of cable to Einthoven's laboratory. His 1906 Le Télécardiogramme described the circuit, its interference problems, limb leads, normal deflections, and hospital cases. This “telecardiogram” was remote measurement within one institution, not modern digital telemedicine (Einthoven).
6. 1905-1912: the Cambridge Scientific Instrument Company, working with Einthoven and engineers including William Duddell, makes the galvanometer smaller and more robust. The first complete Cambridge electrocardiograph went to E. A. Schäfer at Edinburgh University in January 1908; by 1912 commercial models could be installed in hospitals and consulting rooms (Burnett).
7. 1909-1913: Thomas Lewis and colleagues at University College Hospital connect laboratory patterns with clinical rhythm disorders, publish on electrocardiography, and teach its interpretation. Lewis's 1913 Clinical Electrocardiography helped translate a research technique for physicians (Lewis, 1909; Lewis, 1913).
8. 1913: Einthoven, George Fahr, and Adriaan de Waart formalize the relation among the three standard limb leads, usually represented as Einthoven's triangle. A lead is a view defined by electrical connections, not simply an electrode or a picture of one anatomical part of the heart (Nobel presentation speech).
9. 1924: the Nobel Prize in Physiology or Medicine is awarded to Einthoven “for his discovery of the mechanism of the electrocardiogram.” The official wording recognizes both instrument and interpretation; it does not establish that he alone originated every part of electrocardiography (Nobel Prize).
10. 1934-1954: Frank Wilson and colleagues develop a central terminal and standardized chest leads; Emanuel Goldberger adds augmented limb leads in 1942. Professional recommendations in 1938 and 1954 consolidate the familiar twelve-lead arrangement, long after the string galvanometer's debut (AlGhatrif and Lindsay).

Einthoven's 1903 Leiden apparatus filled two rooms, used a large water-cooled electromagnet, and required five operators. Light magnified the shadow of the moving filament onto photographic material. Patients completed the circuit by placing hands or a hand and foot in jars of salt solution. Temperature, vibration, electrical interference, string tension, and calibration could all affect the record (Burnett; Einthoven).

The 1905 hospital connection divided work between two groups: staff and patient at the hospital, and operators with the galvanometer and camera in the physiological laboratory. Einthoven's published account names professors, technical helpers, and firms involved in the cable, while the patients appear mainly as specimens of a healthy or diseased trace. The paper is invaluable technical testimony, but it tells us much less about what patients understood or experienced than about the recording system (Einthoven).

Commercial manufacture changed what counted as a usable instrument. Cambridge staff enclosed the delicate string against drafts, solved problems in silvering quartz fibres, integrated optics and camera, and reduced the apparatus. Company records show that many early buyers were physiology laboratories, while some galvanometers went to telegraphy and other technical users. Before about 1910, clinical diagnosis was still a hoped-for application rather than the instrument's dominant setting (Burnett).

British work on irregular rhythm did not begin with the ECG. James Mackenzie used a polygraph to compare arterial and jugular venous pulses, and clinicians already described the completely irregular pulse as delirium cordis or arrhythmia perpetua. These historical labels did not always denote exactly the same entity. Early writers also used auricle where current anatomy normally says atrium (Lawrence; Moss).

In 1909 Carl Julius Rothberger and Heinrich Winterberg described electrocardiographic findings of fibrillation in experimental animals and patients. A few months later Lewis independently connected a common clinical irregularity, including cases associated with mitral stenosis, with auricular fibrillation. His brief British Medical Journal report and subsequent investigations helped make the identification clinically persuasive, but the sequence resists a lone-discoverer story (Lewis, 1909; Moss).

Lewis's importance lay in sustained correlation: he compared electrical records with pulse tracings, experiments, symptoms, and the course of disease, then circulated interpretations through articles and books. In 1912 he emphasized diagnostic uses while also spelling out cases in which the tracing did not settle the diagnosis. His work exemplified the “new cardiology” built around demonstrable mechanisms, but that approach met clinicians who feared technical specialization or the neglect of bedside judgement (Lewis, 1912; Lawrence).

Calling Einthoven the “father of electrocardiography” recognizes an exceptional combination of mathematical correction, instrument design, lead conventions, and physiological interpretation. Used as a complete origin story, however, the phrase obscures Waller's published surface work, industrial technologies, instrument makers, hospital organization, clinical investigators, and the later architects of the twelve-lead system. Credit is clearer when attached to specific contributions (Burnett; Nobel Prize).

By the mid-twentieth century, amplifiers, direct-writing mechanisms, portable equipment, standardized leads, and professional training had removed much of the labour visible in Einthoven's laboratory. The ECG became a routine hospital record and a model for monitoring technologies: physiological events could be made into comparable lines, stored in a case record, and interpreted at a distance from the patient's body.

That success did not make the line neutral. Electrocardiography helped redistribute authority toward hospitals, specialists, and technical systems able to purchase, maintain, and read the apparatus. It also gave clinicians genuinely new knowledge. The important history is the tension between those facts, not a choice between bedside medicine and machines (Lawrence).