History of the Disorders of Cardiac Rhythm (review)

The incessant rhythmic action of the heart is one of nature’s most remarkable phenomena. People have had palpitations and physicians have felt the pulse since antiquity, but the mechanism of the heartbeat was poorly understood until the twentieth century. This book is a concise, well-illustrated summary of the growth of knowledge about the pathophysiology, diagnosis, and treatment of disorders of the heartbeat. Written by a prominent German cardiologist and electrophysiologist, it reflects his three-decade experience as a scientist and clinical investigator interested in cardiac arrhythmias.

Lüderitz describes but does not attempt to interpret the history of cardiac arrhythmias. He acknowledges in his introduction that “the historical aspect of this book is not in any way intended to compete with the work of medical historians” (p. viii). This book was written mainly for persons with some background in physiology or medicine. Although there is a glossary of several dozen technical words and phrases, the nonmedical reader may find it difficult to follow some parts of the text. Portions of the book (especially those devoted to current diagnosis and treatment) are more a state-of-the-art review of cardiac electrophysiology than a history.

After a brief summary of the pulse lore of ancient China, Egypt, and Greece, Lüderitz recounts the major pathological and clinical observations and research findings of the past four centuries that helped scientists and clinicians construct a framework for interpreting and understanding the heart’s electrical system in health and disease. The body of the book is organized around the many eponyms associated with the cardiac conduction system and the pathophysiology of arrhythmias. Lüderitz describes concisely and clearly the main contributions of several scientists and clinical investigators remembered for their observations in these areas. Although this brief work was not envisioned as a comprehensive survey of cardiac electrophysiology, there are some surprising omissions; for example, the Scottish physician James Mackenzie, a leading clinical investigator of cardiac arrhythmias in the preelectrocardiographic era, is not mentioned.

I found two inaccuracies that should be noted. The author perpetuates a common error with respect to the year in which the Dutch physiologist Willem Einthoven first reported his invention of the electrocardiograph; like most other historians, Lüderitz cites Einthoven’s 1903 paper in German, apparently unaware that the text was first published the preceding year in Dutch. He also states that Paul Dudley White “built the first ECG laboratory outside of England in 1914” (p. 42); by this time, however, electrocardiographs had been installed in several hospitals and laboratories in Europe and the United States.

This attractive book includes 118 illustrations—mainly portraits, electrocardiographic tracings, reproductions of title pages or illustrations from important works, and prints of plants from which cardiac drugs have been derived. Most of the illustrations are of high quality and many are in color. The bibliography includes 368 references, the majority of them primary sources published during the past century. There are separate name and subject indexes. Despite its brevity, this book is a useful addition to the rapidly expanding literature of the history of cardiology.