Milestone-Proposal talk:String galvanometer to record the human electrocardiogram

Advocate for this Milestone Proposal -- John Vardalas (talk) 18:17, 6 February 2019 (UTC)

To the Benelux Section

I will the be advocate within the IEEE History Committee for this Milestone proposal. I must commend the Benelux Section for putting together an excellent proposal. I am confident that, together, we can move this proposal through to approval.

I must select two external expert referees to comment on the proposal. I would welcome any suggestions.

Before I approach the external referees, we should first make sure that we have a good citation. I think that we may have to rework the wording of the citation. I will be in a position to make more concrete suggestions in this matter once I have dug more deeply into the available literature relevant to this proposal. In the meantime, could the proposers answer the following questions. 1) Where was Willem Einthoven's laboratory located? 2) What are the references on which the proposal based its description of Cambridge Scientific Instruments involvement?

John Vardalas, Ph.D. Member, IEEE History Committee

Reply to talk of Vardalas -- Wvetten (talk) 18:01, 28 February 2019 (UTC)

We thank the advocate John Vardalas for his positive response on our Milestone proposal and look forward to cooperate to achieve the approval of it. About adapting the wordings of the citation we are eager as well to improve the text.

For the moment let us answer the questions put forward by the advocate.

Q: 1) Where was Willem Einthoven's laboratory located?

A: Einthoven's laboratory was in the center of the city of Leiden, about 1500 m remote from the Academic Hospital Leiden (nowadays Leiden University Medical Center). Einthoven’s version of the string galvanometer was so heavy that it was very unpractical to transport it to the hospital. Therefore he decided to transmit the electrocardiogram over a telephone wire pair, so that both the galvanometer and the patient could stay in place. The building where Einthoven’s laboratory was in nowadays hosts the National Museum of Ethnology.

Q: 2) What are the references on which the proposal based its description of Cambridge Scientific Instruments involvement?

A: This involvement becomes clear from the exchange of letters between Einthoven and this company. Those letters are in the personal archive of Einthoven. This archive is at the Museum Boerhaave and is available for researchers.

In a private communication to John Vardalas we will bring forward suggestions for reviewers.

Re: Reply to talk of Vardalas -- John Vardalas (talk) 18:39, 3 April 2019 (UTC)

Replace this text with your reply

Though not needed for establishing the validity of this Milestone, it would helpful to the reader if this supporting evidence gives a short summary, perhaps a paragraph or two, on the role of Cambridge Scientific Instruments. This additional information would satisfy the needs of most readers while also prompting researchers to further examine the archive in Museum Boerhaave. To be clear, from my perspective, this additional information is not required for the approval process, but it would be nice to have in the ETHW public record.

Review of proposal from Dr. David Geselowitz -- John Vardalas (talk) 22:18, 26 March 2019 (UTC)

Prof. David Geselowitz is a noted expert in the field. He was elected to the National Academy of Engineering for his “outstanding contributions of engineering theory and technology to electrocardiographic fundamentals and diagnoses”.

His assessment is short but unequivocal.

"I find the proposal excellent. Einthoven's work clearly merits celebration on two scores. One is the development of the string galvanometer. The other is the development of electrocardiography."

Review of proposal from Dr. David Rhees -- John Vardalas (talk) 22:41, 26 March 2019 (UTC)

In reviewing this proposal, Dr. David Rhees answered three questions: 1) Is the wording of the Plaque Citation accurate? 2) Is the evidence presented of sufficient substance and accuracy to support the Citation? 3) Does the proposed milestone represent a significant technical achievement? His answers are quoted below.

1) Is the wording of the Plaque Citation accurate?

"The wording of the first sentence implies this was the first electrocardiogram made of a patient in that hospital, whereas I believe the correct intent is to state it was the first successful electrocardiogram made of any patient anywhere.

However, there is another issue. This plaque will be located at the approximate site where the patient was recorded, so it really commemorates the site. As noted in the proposal, the string galvanometer itself was too heavy to be moved to the hospital and was located 1.5 km away in Einthoven’s laboratory. Moreover, there is no actual artifact of the string galvanometer at the site of the proposed plaque (I once visited the Museum Boerhaave, also in Leiden, which I believe has the original device or an early version). Thus, there are 3 potential sites for a plaque: the proposed one in this hospital, the site of Einthoven’s lab nearby, and the Boerhaave Museum. I don’t have a problem with using the approximate site where the patient was recorded, as is proposed, but would recommend that a small exhibit panel be placed close to the plaque with an image of the device at the Boerhaave Museum, a photo of a patient (as is included in the proposal), and additional explanation."

Assuming I am correct, the body of the citation might be amended as follows:

Invention of the string galvanometer electrocardiograph by Willem Einthoven (1886-1927). On this location, in a previous building, the first successful electrocardiogram of a patient was recorded on March 22, 1905 in this hospital, transmitted by telephone line to Einthoven’s laboratory located at [insert location]. The development of the string galvanometer by Einthoven marked the starting point of electrocardiography as a major clinical diagnostic tool. Einthoven, “Father of Electrocardiography”, was awarded the 1924 Nobel Prize in Physiology or Medicine."

2) Is the evidence presented of sufficient substance and accuracy to support the Citation?

"Yes, though mostly primary sources. Would have been helpful to cite secondary sources."

3)Does the proposed milestone represent a significant technical achievement?

"Absolutely!"

Dr. Rhees is an historian of science and former Director of the Bakken Museum. Located in Minneapolis, Minnesota, United States, The Bakken Museum is the world's only library and museum devoted to medical electricity.

Possible rewording of citation -- John Vardalas (talk) 18:20, 3 April 2019 (UTC)

Since the instrument itself, and hence the recording, was located in Dr. Einthoven's laboratory, which was at some distance from the hospital, I wonder if the word "recorded" could be misleading. Perhaps "taken" is a better verb. I also recommend moving "in this hospital" after the verb to make it clear that the Milestone is for the "first successful electrocardiogram of a patient" and not for the "first successful electrocardiogram of a patient in this hospital" What does the nominator think of the following plaque citation:

Invention of the string galvanometer electrocardiograph by Willem Einthoven (1886-1927), with which the first successful electrocardiogram of a patient was taken, in this hospital, on March 22, 1905. The development of the string galvanometer by Einthoven marked the starting point of electrocardiography as a major clinical diagnostic tool. Einthoven, “Father of Electrocardiography”, was awarded the 1924 Nobel Prize in Physiology or Medicine.

Re: Reply to the reviewers and the advocate -- Wvetten (talk) 14:48, 21 April 2019 (UTC)

We thank the reviewers and the advocate for their positive comments, which are valuably and we will use them to improve the application.

The comment of Dr. Geselowitz is self explaining and needs no further action.

The comments of Dr. Rhees are threefold: A: The wording of the citation. B: Please, cite secondary sources. C: Place a small exhibit panel with an image of the original device, a photo of a patient and additional explanation close to the plaque.

Ad A: The proposed citation goes far beyond the number of words limit prescribed by the History Committee. We believe that the proposal of the advocate on the one hand meets the raised problem with the original citation and on the other hand fits in the maximum amount of words allowed. So, we changed the original citation proposal into that proposed by John Vardalas.

Ad B: There are several secondary sources given, such as Refs. [16], [17] and [18]. In a revised version of the proposal we added another secondary source, numbered [19].

Ad C: This is a very interesting idea. We will contact the site owner to discuss the opportunities therefor.

The comments of the advocate Dr. John Vardalas.

In the foregoing we already adopted his improved version of the plaque citation.

In the text we added two paragraphs on CSI.

Re: Re: Reply to the reviewers and the advocate -- John Vardalas (talk) 21:41, 27 April 2019 (UTC)

I've recommended that the History Committee approve your Milestone nomination. The vote will take place at the next History Committee meeting in Sept. 2019

-- M.j.bastiaans (talk) 11:21, 14 September 2019 (UTC)

This Milestone has my support, including the latest version of the citation.

-- JaninA (talk) 11:45, 14 September 2019 (UTC)

I support this Milestone with the final Citation.

Recommend revision in Milestone citation -- John Vardalas (talk) 05:46, 26 September 2019 (UTC)

At the last History Committee meeting, time ran out before we could conclude discussions and vote on this Milestone proposal. The vote will be taken at the upcoming History Committee meeting on 2 October 2019. It became clear from Committee member remarks that the wording of the citation could be improved. For the record, the original citation is

“The first successful human electrocardiogram was recorded on 22 March 1905 from a patient in Leiden University Hospital connected via telephone line to a string galvanometer in a laboratory 1.5 km away. Willem Einthoven’s invention of the string galvanometer marked the beginning of electrocardiography as a major clinical diagnostic tool. Einthoven, “Father of Electrocardiography”, was awarded the 1924 Nobel Prize in Physiology or Medicine.”

I recommend that the proposers consider the following revision

"On 22 March 1905, the first successful clinical recording of a human electrocardiogram (ECG) took place at this location, which at the time was the Academic Hospital Leiden. Willem Einthoven’s pioneering work, from 1901 to 1905, to develop a new string galvanometer, specifically to measure and record the heart’s electrical activity, made this medical achievement possible. This invention marked the beginning of electrocardiography as a major clinical diagnostic tool."

The word “new” in the second sentence recognizes Clement Ada’s work in telegraphy. In 1897 he developed a string galvanometer to increase the speed of telegraphic transmissions. This technology was totally unsuited for the sensitivity and bandwidth needed to measure and record the heart’s electrical activity. There is good scholarship that shows that Einthoven invented a new kind of string galvanometer to meet the challenge. Einthoven was the first to acknowledge Ada’s telegraphy innovation. The qualifying clause “specifically to measure and record the heart’s electrical activity” serves to underscore that the search for an adequate medical instrument drove this innovation. Otherwise the reader might think that the electrocardiogram was a fortuitous, after the fact, application of his new string galvanometer. Reference to the Noble Prize was deleted in order to stay within the 70 word limit. Though impressive, mention of the Noble Prize is not essential. The last sentence establishes the great impact of Einthoven’s invention.

Re: Recommend revision in Milestone citation -- Wvetten (talk) 07:39, 26 September 2019 (UTC)

I can fully agree with this renewed citation. Furthermore, I understand that the History Committee asked for further reference with respect to the date of 22 March 1905. This can be found in Reference [7] on page 127 of the original proposal, where Einthoven reports this date.

In will change the text of the proposal accordingly.

Re: Re: Recommend revision in Milestone citation -- Jbart64 (talk) 16:10, 26 September 2019 (UTC)

I agree with and fully support the milestone. I do suggest some tighter wording as follows. Since we try to celebrate achievements, and not just inventions, I added the idea of helping to create a new medical field. The word "helping" is critical since Einthoven was not the first to explore the electricity of the heart, and he did acknowledge Ader as another inventor of a similar string galvanometer (that was not sensitive enough for medical uses). Nevertheless, Einthoven is generally considered the founder of this new diagnostic field. Dave Bart

Suggested Wording: On 22 March 1905, the first successful clinical recording of a human electrocardiogram (ECG) took place at this location, which at the time was the Academic Hospital Leiden. From 1901 to 1905, Willem Einthoven developed a new type of string galvanometer that specifically measured and recorded the heart’s electrical activity. This invention marked the beginning of electrocardiography as a major clinical diagnostic tool, helping establish a new diagnostic medical field.

opposition -- Allisonmarsh (talk) 16:34, 26 September 2019 (UTC)

I remain opposed to citations that name inventors where the names are not eponymous with their invention.

Re: opposition -- John Vardalas (talk) 14:28, 27 September 2019 (UTC)

I strongly disagree with Allison’s position. I do not believe that the Committee should start slavishly insisting on eponymous names in Milestone citations.

1)The guidelines for a Milestone stipulate that this award honors an achievement, rather than a place or person. But achievements occur in a place and by human agency. To my mind, the Milestone title, recognizes the achievement and the citation provides the needed context of time, place(s) and of the people behind the achievement. Past IEEE Milestone citations have struck this balance. For example, in the dedications for the past 5 years, about 20 citations have named specific people behind the achievement, and they are not eponymous names. The remaining citations name some organizational unit because the achievement encompassed too many people to list. The corporation is the most prominent one. In some sense then, if we accept the legal view that corporations are people then all the Milestone citations use people’s names.

2) The citation provided for this specific Milestone honors, first and foremost the achievement then is gives context and impact. Part of that context is Einthoven who created this innovation just for this scientific breakthrough. Though I do not believe that the name need be eponymous, as I argue above, there is a case to be made for this invention. The scholarship on this first electrocardiogram ties Einthoven’s name to the device used. Instead of string galvanometer one often reads “Einthoven’s string galvanometer”. In more popular accounts, the Encyclopedia Britannica or even Wikipedia the instrument is called “the Einthoven galvanometer”. In the initial years, I do not believe that medical research labs were just buying any string galvanometer. They were buying an Einthoven galvanometer.

Re: Re: opposition -- Wvetten (talk) 09:31, 29 September 2019 (UTC)

I fully agree with John. I believe that Allison's position not mentioning names in a citation is a personal view, which is not shared by that of the majority of committee members in the past. In 2011 a milestone was awarded to the discovery of superconductivity. In the citation not only the name of Kamerlingh Onnes was mentioned but even the names of three of his collaborators were presented.

Despite the fact that Einthoven actually didn't invent the string galvanometer his contributions to the development of this instrument are so significant that, as John says, it is mostly called "Einthoven galvanometer". The original device developed by Ader was intended to be used for the detection of telegraph signals and even in that area it didn't reach the stage of practical application. It was completely unsuited for the recording of electrocardiograms. Only Einthoven's device was sensitive enough to show the details of it.

When browsing the internet with search phrase "string galvanometer" most results refer to Einthoven.

Comment E Tejera -- E.tejera (talk) 20:34, 1 October 2019 (UTC)

I agree with John´s comments.

It seems that maintaining the name in this case is important to show the contribution.

Enrique Tejera

Citation -- JaninA (talk) 21:09, 1 October 2019 (UTC)

What about replacing the word "new" with "highly sensitive" in John's latest version?

Re: Citation -- John Vardalas (talk) 09:14, 2 October 2019 (UTC)

In weighing the pros and cons of the above suggestion. I would like to add the following to the mix.

In 1985, in the journal Medical History, John Burnett, then with the Wellcome Museum of Medical History in London, wrote a lengthy piece on the origins of the electrocardiograph as a medical instrument. After devoting a section on Ada's string galvanometer, Burnett still refers to Einthoven's instrument as "a new form of galvanometer". I just borrowed the word "new" from Burnett, and added "kind" instead of "form" when I worked with the proposer on this citation. Yes, Einthoven's string galvanometer was much more sensitive, but also new optical and recording components were added that made it into a useful medical instrument.

Citation -- JaninA (talk) 12:13, 2 October 2019 (UTC)

John, what about replacing "new with "high sensitivity" and adding the words about optical and recording components (you are talking about) to the Citation. Before "made this medical achievement possible". If not, then I suggest to replace "new" with "novel". The word "new" is very non-technical and too general.

Re: Citation -- John Vardalas (talk) 18:29, 2 October 2019 (UTC)

I believe that the first part of your suggestion leads us into the weeds of the device's design and construction, which may be more that just the elements that I cited. If the word "new" troubles you, then I tend to want to go with the idea raised in your last sentence. But I'm unsure of the proper word. At this point I cannot speak for the proposers.