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Augustus Desire Waller was the first to record a human electrocardiogram using a mercury capillary electrometer.
His work was continued and the instrument further improved by Willem Einthoven. Augustus Desire Waller was born in Paris on the 18th July 1856, the scion of an eminent scientist, Augustus Volney Waller, who was noted for his work on nerve degeneration, now eponymously known to us as Wallerian degeneration. Augustus Waller was in Switzerland when he started his schooling at the College de Geneve.
Not surprisingly, he became absolutely fluent in French and later on he usually communicated his research work in both English and French. Young Waller lost his father and role model in 1870, when the boy was only 14 years old. Even at that tender age, Augustus Desire wanted to emulate his father. The boy’s upbringing now rested on the shoulders of his mother, Matilda Margaret Walls, who, for personal reasons, moved with her son to Aberdeen, Scotland, where eventually he studied medicine at Aberdeen and Edinburgh.
He received his degree in medicine 1878 and doctorate in 1881. Released from his studies, Waller soon migrated down to London to join the department of Physiology at the University College of London to work under Sir John Burdon Sanderson. Immediately upon graduation, Waller began his lifelong career in physiology, contributing a great deal to this discipline in due course.
In 1883 he became lecturer in Physiology at the Royal Free Hospital where he met his future wife, Alice Mary Palmer, then a medical student. Alice was the daughter of Sir George Palmer (of Huntley and Palmers Cheese Biscuit Empire). They married in 1885 and he was greeted on his return with the blackboard scribbled with ‘Waller takes the biscuit’.
In good humour, Waller added ‘and the tin as well’. They were an ideal couple with Alice often helping or participating in Waller’s work. They had three sons and two daughters, one of whom drowned while still young. His surviving daughter, Mary Waller, later went on to excite vibrations in metal using dry ice.
In 1884 he was also appointed lecturer in physiology at St. Mary’s Hospital in Paddington. Waller remained at St. Mary’s until 1903, when he was appointed professor of the newly established physiologic laboratory at the University of London.
This was followed very shortly by his appointment as consulting cardiologist to the National Heart Hospital in London where he continued his clinical investigations in electrocardiography.
Following in his father’s footsteps, Waller went on to be elected to the Royal Society in 1892 and become the Director of the Physiological Laboratory at the University of London. He held similar posts in Paris, Moscow, Rome and Belgium. His textbook “An Introduction to Human Physiology", published in 1891, was at that time a comprehensive treatise on the subject.
His research interests were in the emerging field of electro-physiology. Back in 1842, an Italian physicist Carlo Matteucci had shown that in animals an electrical current preceded every heartbeat. And soon everybody was trying to measure these electrical currents, including Waller.
The search for improved measuring devices continued until the mercury capillary electrometer was invented by Gabriel Lippmann in 1875. Augustus Waller wrote the following passage about the device: “The instrument is, in fact, an exceedingly delicate electrical manometer; a rise of electrical pressure on the mercury side or a fall of electrical pressure on the sulphuric acid side, causes the mercury to move towards the point of the capillary; a fall of electrical pressure on the mercury side or a rise on the sulphuric acid side, causes the mercury to recede from the point of the capillary.
The instrument accordingly is an indicator of “potential” or “pressure"; not of “current.” Its delicacy is such that it will react to as little as 1/40,000 volt. It offers, moreover, the following advantages: the indications are practically instantaneous, free of lost time, and of after-oscillation; the resistance in the circuit is immaterial; unpolarisable electrodes may for most purposes be dispensed with.”
Although Marey recorded the first electrocardiogram using the mercury capillary electrometer in 1876, Waller was the first to record the electrocardiogram of a human heart. Sir Thomas Lewis wrote the following statement about his contribution: “Waller was the first to show that currents set up in the beating of the human heart can be recorded; he was the first to obtain a human electrocardiogram.”
The electrical current that starts a heartbeat is minuscule and at that time the only way to detect it was by attaching electrodes directly onto the heart. Even so, a very sensitive device was needed for measuring the change in voltage. Waller used a contraption invented by Gabriel Lippmann - the capillary electrometer. It consists of a fine glass tube, with mercury at the bottom and dilute sulphuric acid on top. A change in electrical charge causes the surface tension of the mercury to alter, sending the mercury shooting up or down the tube.
Lippmann capillary galvanoscope shown here uses the same principle as the instrument used by Waller and later by Einthoven, but it has slightly different configuration. A small drop of mercury in the horizontal capillary tube moves under the influence of an electric field applied to the two electrodes. The device is provided with a glass scale for projection.
But even with a really sensitive electrometer, Waller only got movement of a fraction of a millimetre for each heartbeat. He decided to project an image of the mercury, which would enlarge it. He then needed to record the pulses, and for this he had a really ingenious system.
Waller shielded off all the light apart from that shining through the capillary column. He then put a photographic plate on a toy wagon, which was pulled along by a weight. Now, as the mercury went up and down, it interrupted the light casting a shadow and leaving the photographic plate unexposed behind the mercury.
Until 1887, this was just an experimental system used on animals, as the electrodes had to be attached directly to the heart. Then Waller had his brainwave. The body itself conducts electricity to some extent. So why not use the body itself instead of attaching electrodes to the heart? He envisaged using the limbs as sort of extension cables.
He set to work - on himself. To make electrical contact, he used metal bowls of salty water, into which he could dip hands or feet. What Waller discovered was that if he put his left foot in one basin and right hand in the other, he got an electrical blip on the trace. He carefully analysed the traces and proved that a tiny fraction of a second before each beat of the heart there is an electrical blip. He had invented the electrocardiogram (ECG) and was the first person to record the electrical pulse of a working human heart.
But he didn’t stop there. He tried different combinations of limbs, even putting a spoon in his mouth, and almost all of the different combinations gave the same basic pattern. However, when he tried his right foot and his left hand, or both feet, he got no electrical pulse at all. Waller realised that the electricity in the pulse starts at one end of the heart and runs to the other.
Because your heart sits at a slight angle in the chest, to record a pulse you need to measure from one side of the body’s electrical system to the other. Your head and right arm are one side, and the rest of your body the other side. Waller guessed that the electrical signal started at the bottom of the heart and ran up. More sensitive instruments mean that we now know that the impulse actually starts at the top of the heart and runs down.
Waller was determined to be as successful as his father was in physiology and his ambition was to become a Professor. His ambition was briefly sated in 1895 when he was appointed Fullerian Professor at the Royal Institution, but he resigned within a year due to inadequate facilities. However, in 1903 he was appointed Honorary Director of the Physiological Laboratory at the University of London, with the much sought-after title of Professor of Physiology.
Waller lived physiology. He wasn’t much concerned with its practical application to medicine, he thought that physiologists should discover how the body worked and then anything applicable to medicine should be developed by someone else. He had a laboratory built as part of his home, and his wife and children were often called upon as experimental subjects, with Waller even taking an air raid warning as a chance to monitor his wife’s emotional response to stress.
He looked different to other physicians who were always soberly garbed in frock coats or morning coats and silk hats, instead he always wore a double-breasted blue suit, which made him look exactly like a skipper in the merchant navy. Waller was a short stocky man who was light on his feet, with an intelligent face and a small pointed beard. Like Sir Winston, he seemed to be habitually smoking cigars, and was invariably followed by his bulldog, Jimmy, who also had a Churchillian quality and had the distinction of having had a question asked about him in the House of Commons.
Q. ‘At a converzaione [sic] of the Royal Society at Burlington House on May 12th last, a bulldog was cruelly treated when a leather strap with sharp nails was wound around his neck and his feet were immersed in glass jars containing salts in solution, and the jars in turn were connected with wires to galvanometers. Such a cruel procedure should surely be dealt with under the “Cruelty to Animals Act” of 1876?’
A. ‘The dog in question wore a leather collar ornamented with brass studs, and he was placed to stand in water to which some sodium chloride had been added, or in other words, common salt. If my honourable friend had ever paddled in the sea, he will appreciate fully the sensation obtained thereby from this simple pleasurable experience!’
In 1909, Waller gave a lecture about the ECG in front of the Royal Society with his bulldog Jimmie as the subject, standing with his paws in salt solution. This prompted irate spectators to write a letter to the Lancet. They complained that the poor dog had undergone ‘an ordeal by electricity’, being forced to stand in water containing ‘that intensively corrosive metal sodium and that very poisonous gas chlorine’, and worse still, there were ‘at least two bishops’ in the audience.
Waller also maintained a private physiologic laboratory at his spacious home in St. John’s Wood, London. He was helped here by his wife who had qualified in medicine but never practiced her profession. His children were often the subject of his electrocardiographic studies, but his best known subject was his bulldog, Jimmy. There are many photographs of Jimmy either by his side or standing in a tray of saline having an electrocardiogram taken.
Waller and his famous dog Jimmy. Source: Besterman E., Creese R.L. Waller - pioneer of electrocardiography. Br. Heart J. 1979, 42, 61-64.
Perhaps the biggest supporter of Waller in his role as a pioneering force of electrocardiography was Edwin Besterman and his colleagues of the Waller cardiopulmonary unit at St. Mary’s Hospital in London. Waller’s initial work on electrocardiography was conducted at St. Mary’s Hospital, and it was there that he gave the first public demonstration of his recording device. Waller’s original apparatus and some of the tracings obtained with it are still housed in this unit.
It is true that Alexander Muirhead may have been the first to record a human electrocardiogram, but Waller was the first to do so in a combined clinico-physiologic setting, the first to publish a report on his findings, and a pioneer in acquiring extensive experience with this new diagnostic modality.
Muirhead conducted his investigations with a Thompson siphon recorder at St. Bartholomew’s Hospital in 1869 or 1870. The device had been designed by William Thompson to record signals passing through the newly laid transatlantic cable. Prior to this, electric potentials of the heart were obtained from exposed animal hearts.
Initially, Waller had said “I do not imagine that electrocardiography is likely to find any very extensive use in the hospital. It can at most be of rare and occasional use to afford a record of some rare anomaly of cardiac action.” No doubt, his continued usage of the modality caused him to change his mind because in 1917, just six years after expressing this sentiment, Waller presented before the Physiological Society of London a paper entitled “A Preliminary Survey of 2,000 Electrocardiograms.”
This was also the first time that he used the word “electrocardiogram” in an official manner; prior to this he had referred to the tracings as “electrograms.” This raises the question as to who really coined the word “electrocardiogram.” Einthoven attributed it to Waller, as did Waller’s daughter, herself a lecturer in physics. Sykes, however, found no evidence of this, advancing on the other hand the proposition that Einthoven really coined the term but attributed it to Waller as a token of respect and generosity toward his colleague.
The groundwork for Waller’s presentation to the Physiological Society began in 1887 and 1888 when he published his findings, first, on electric potentials obtained from intact living animals, and then from the limbs and chest of humans.
He used the Lippmann capillary electrometer to deflect a light beam from the recording of these electrical forces. The Lippmann capillary electrometer was a far better device than the siphon recorder for measuring the electrical activity of the heart. His publications include: Introdution to Human Physiology, 1891, Animal Electricity, 1897; Signs of Life, 1903; Physiology, the Servant of Medicine, 1910; The Psychology of Logic, 1912.
Throughout his career, Waller received many awards in Britain and abroad. A notable one was election as a fellow of the Royal Society at the young age of 35, the same age his father had been at election. Waller’s one consuming pastime was dashing about with the newly invented motor car. He was somewhat of a showman and enjoyed giving popular lectures. His spacious home was often the seat of entertainment for visiting scientists.
Waller died quite suddenly on 11 March 1922, in London, after two strokes. The death of his wife, shortly before, most likely contributed to his. That same year a summary of his electrocardiographic investigations and viewpoints was published in a monograph edited by his son.
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