Willem Einthoven

Willem Einthoven had a long career as professor at Leiden University, from 1886 until his death in 1927. He was a physiologist with strong clinical interests. To Einthoven the ultimate goal of physiology was to understand disease and to benefit patients.

His main scientific interests were those of a physicist and naturally his most important contributions were related to the introduction of physical methods and concepts that could be relevant for clinical medicine. At the same time he clearly realized that the potential clinical benefit of research could only be determined after a period of study and experimentation; in 1906 he wrote a paper entitled "Het tele-cardiogram" (The tele-cardiogram) in which he stated: "We should first endeavor to better understand the working of the heart in all its details, and the cause of a large variety of abnormalities. This will enable us, in a possibly still-distant future and based upon a clear insight and improved knowledge, to give relief to the suffering of our patients." These memorable words have lost nothing of their meaning today and indeed merit serious consideration in view of the increasing pressure to produce early results in research. In the first phase of his research career Einthoven probed into various subjects in the fields of vision and respiration but later he restricted himself almost entirely to electrical phenomena in physiology, in particular those related to the heart. To register electrical currents of the heart he started by using the "Lippmann electrometer" as Waller had done before him. Despite Einthoven's improvements, this instrument failed to satisfy his high standards for accuracy so he soon felt compelled to design a new instrument, the string galvanometer. He achieved such perfection that many modern electrocardiographs, incorporating the latest technological developments in electronics, do not attain equally reliable and undistorted electrocardiographic recordings.

Einthoven could not have done this without his characteristic unbounded capacity for concentration on the problems he was confronted with and an almost prophetic insight into the future clinical significance of the electrocardiogram. Today, the electrocardiogram having evolved into the most widely applied diagnostic tool in patients with diseases of the heart, it is difficult to realize that Einthoven, as he stated himself, still had to prove that diseases of the heart would lead to abnormalities recognizable in the electrocardiogram. In addition to setting the groundwork of this field by constructing the first instrument capable of accurate recording he developed a system of standardization which continues to be followed all over the world. The significance of this for the development of diagnostic electrocardiography can hardly be overestimated.

Einthoven's contributions to the field were recognized in 1924 when he received the Nobel Prize. lt is characteristic of his modesty that accepting the prize he pointed out that the development of electrocardiography had only been made possible by concerted efforts of many workers in this field, among whom he especially mentioned his British friend, Thomas Lewis.

Historical pictures

All comments with the photographs are from the book on Willem Einthoven by prof. Herman Snellen. Figure numbers refer to the numbers of the figures in the book.

Front of the Physiological Laboratory Leiden (around 1920) with added annex for electrical insatllation at the right.

Illustration composed from and comparing three subsequent episodes of electrocardiographical development.

1) Upper part: Waller 1887. t=time, h=external pulsation from heartbeat usually called cardiogram (after Marey), e=electrical heart action, showing 2 peaks directed downwards. The cardiac action current is rather inconspicious and was later often confused with the cardiogram above it.

2) Einthoven's tracing as published in 1902, also with Lippmans electrometer. Four peaks (ABCD) directed upwards because of reversed connection. Timescale in 0.1 sec above tracing. Below that, the same tracing corrected mathematically. Timescale in 0.1 sec is stretched (S); the four peaks in the corrected tracing are now called PQRST.

3) One of the first electrocardiograms with the string galvanometer as published in 1902 and 1903.

Finished string galvanometer.

The long sides of the magnet are covered together by the windings of the tube for water cooling.

Patient sitting in the University Hospital while his telecardiogram is being taken in the physiological laboratory.
The hands are immersed in strong salt (NaCl) solution.

Willem Einthoven when rector of the senate of the University in 1906.

Einthoven's co-workers and guests from abroad in the early 1920's.

The Einthoven's in 1924.
Standing behind them Mrs. Eitnhoven's sister, Mrs de Voogd, who joined them on their journey to America. For the two ladies this was mainly an independent trip. Einthoven was here in his happy old age.

One of the last pictures of Einthoven. His signature can be seen against the background of the dark chair.

Grave of Willem Einthoven, his wife and his son; on both sides of it the graves of Mrs Einthoven's relatives.

At the back the Green Church in Oegstgeest. It was built on the site of a wooden chapel reputed to have been consecrated by St. Willibrord in the 8th century. In the 11th century the (tuff stone) church was built, subsequently destroyed in the war againts Spain and rebuilt in the 17th century on the old foundations.

Scientific co-workers in Einthoven's laboratory during World War I (probably 1916 or 1917).

Standing from left to right: W.F. Einthoven (son), Hugenholtz (later general physician near Leiden), Waar (later general physician at the Hague), Flohil, Bijtel. Sitting: W.Einthoven (left) and Bergansius (physicist).

Einthoven Lectures

To commemorate its Nobel Prize Laureate, in 1956 the University of Leiden established the Einthoven Lecture and Einthoven Award. lt was decided to organize this event biennially and to present the Einthoven Award to a physician of international renown who had made outstanding contributions to the field of cardiology, including fundamental as well as clinical aspects. The first speaker was Dr Paul Dudley White, a recognized pioneer in clinical cardiology and a gifted teacher, who was to be followed by many other scientists and clinicians of equal esteem (see below). Traditionally the award is presented by the Rector of the University in a typical academic setting and in the presence of members of the Einthoven family.

Year Speaker Title
1956 P.D. White Personal observations on the evolution of cardio-vascular surgery.
1958 A. Cournand Pulmonary circulation. Historical background and present status of knowledge in man.
1962 L.N. Katz Recent concepts on the perforrnance of the heart.
1964 H.C. Burger Het begrip “arbeid" in natuurkunde, fysiologie en geneeskunde (The concept of labour in physics, physiology and medicine)
1967 H.B. Burchell Mitral competence and incompetence.
1968 D. Durrer Woord en wederwoord (Word and repartee)
1970 E. Braunwald The control of the oxygen consumption of the heart.
1972 W.B. Kannel The natural history of myocardial infarction: The Framingham Study.
1974 H.V. Pipberger Computer analysis of the electrocardiogram
1977 H.A. Snellen Brief review of Einthoven's publications
1979 A.C. Guyton Historical and modern developments of cardiovascular control concepts.
1981 J.T. Shepherd Regulation of blood pressure
1983 P.F. Cranefield Past and future aspects of arrhythmias
1985 J.W. Kirklin Is progress still being made in the surgical treatment of valvular heart disease?
1987 D. Steinberg Plasma lipoproteins and the pathogenesis of atherosclerosis
1989 A.T. Winfree Rate, rhythm and fibrillation.
1990 H.J.J. Wellens Electrical current in the diagnosis and treatment of cardiac diseases.
1991 P. Coumel Modern Cardiology: From treatment to diagnosis ?
1993 T.N. James Willem Einthoven Redivivus: Exemplar of World Cardiology. With added comments upon apoptosis and electrocardiography
1995 R. Favaloro Past and present controversies in coronary artery surgery
1997 E.G. Nabel Gene therapy and cardiovascular disease
1999 K. Schwartz Hypertrophy: clinical relevance of genotype
2002 M.R. Rosen The ECG 100 years later: electrical insights into molecular messages
2004 P. Carmeliet Genetics in zebra fish, tadpoles, mice and humans to unravel the molecular basis of vessel deveiopment
2005 S. Rahimtoola Cardiovascular disease in women: Time for women to take charge
2006 H. Drexler Stem cell therapy of patients with endstage heart failure
2007 P.W.J.C. Serruys Future of interventional cardiology
2008 A.N. DeMaria How to translate scientific literature into clinical practice: from JACC to bedside
2009 J. Narula Noninvasive imaging of the vulnerable plaque
2010 K-H. Kuck Einthoven lecture: Role of catheter ablation for prevention of sudden death
2011 R.A.E. Dion Einthoven lecture: current status of mitral valve surgery