Letters to the Editor

LETTERS TO THE EDITOR Dear Sir: This letter would be unnecessary if the peer review process were infallible, but it is not. Walter Ehrlich's recent paper on the discovery of the cardiac conduction system contains errors that were brought to his attention by reviewers of previous versions of the paper [I]. I reviewed earlier versions of the essay, for Circulation in 1989 and JAMA in 1991, and provided detailed evidence and multiple citations to refute his interpretation of the discovery of the sinus node. Ehrlich's paper was rejected by those journals, and it is apparent from the published version that he ignored most of my suggestions and those of the other reviewers. As a result, factual errors and misinterpretations are contained in the version published in Perspectives. This letter addresses the misconceptions in Ehrlich's paper as well as the failure of the peer review process in this instance. He closed his essay with the statement, "Truthfulness is, however, especially essential for all scientific disciplines: Truth is worth the battle!" These principles also apply to historical papers. Reviewers, editors, and readers assume that authors submit papers that are factually correct; and that if authors are informed of errors or misinterpretations , they will correct them. In his introduction Ehrlich implied that the traditional view that Keith and Flack discovered the sinus node is incorrect. To support this claim, Ehrlich cited his recollections of his medical training in Prague before World War II. He recalled that he was taught that "the sinus node was discovered by Aschoff and Tawara . . . while the atrioventricular node . . . [was discovered by] Keith and Flack." But he admitted, "I cannot now find this version of events in any book we might have used at that time." Ehrlich's claim that this view is supported by Werner Spalteholz's anatomy textbook does not withstand scrutiny. The plates for Spalteholz's Handatlas der Anatomie des Menschen were engraved in 1895—1903, before Keith and Flack described the sinus node [2]. It was translated into English by Lewellys Barker between 1900 and 1903, also before the description of the sinus node [3]. This is why there is no mention or depiction of the Keith-Flack node in Spalteholz's anatomy! Ehrlich implied, however, that this omission supported his version of history—it does not. This was pointed out to him in the reviewers' comments for the JAMA version. In a further attempt to justify his view, Ehrlich used a rather unorthodox Permission to reprint a letter printed in this section may be obtained only from the author. Perspectives in Biology and Medicine, 36, 4 ¦ Summer 1993 687 source: Mexican artist Diego Rivera's mural depicting events and individuals in the history of cardiology. After suggesting that the mural validates his claim that "a version (crediting the discovery of the sinus node to Tawara and Aschoff) exists," Ehrlich admitted that the mural "is also characterized by several erroneous attributions and omissions." Mexican cardiologist Demetrio Sodi-Pallares, a world leader in electrocardiography, claimed shortly after the mural was completed , "It has been known for many years that the stimulus which releases the necessary electromotive force for activation of the heart arises in the sinoauricular node (S-A node; node of Keith and Flack), then travels through the auricles to reach the auriculoventricular node (A-V node; node of Aschoff and Tawara), thence traverses the bundle of His ... [4, p. 358]. To answer Ehrlich's question regarding which "version" was taught in Mexico—surely it was this traditional account. Ehrlich's attempt to support his claim by using selective quotations from contemporary authors simply demonstrates the vitality of this field of investigation around the turn of the century. Scientists and historians accept a concept articulated by cardiologist George Burch (and many others) that "scientific advancements reflect the contributions of many people" [5, p. 77—78]. Keith and Flack never claimed that they alone made all of the discoveries that led to their recognition of the sinus node. Indeed, as Ehrlich noted, they cited in their 1907 paper the important contributions of Tawara, Wenckebach, and Hering [6]. Ehrlich does not believe that Keith and Flack deserve credit for discovering the sinus node. He...