This defib sits outside my office so I decided to work it into a video and remembered Earl Bakken praising Frankenstein (the movie) for sparking his interest in electricity, which triggered a memory of school science classes where I learned about Galvani, Volta, and how they influenced Mary Shelley.
The invention of the ECG is, in my opinion, one of the greatest advances in medicine on par with the discovery of antibiotics. Pacemakers and defibrillators continue to get better and better and now the ones my colleagues insert (I don't do them anymore. I have sub-specialized in a different -- electromagnetic? -- field) do many different functions, can wirelessly talk to units in the patient's house, transmit information to the hospital, and we are alerted to problems before the patient even realizes. They can also shock patients out of dangerous rhythms. But more than that, they can deliver highly complex therapies to avoid even needing to shock the patient, as it's not very nice.
Watch the video above or read the transcript below:
Francis: What was the first science fiction? Up for debate, but I would submit Mary Shelley's Frankenstein as the first story that truly used real science to inspire fiction. I'm sure you recognize this device to my right, a cardiac defibrillator. To find out how we get from Dr. Frankenstein to this lifesaving device, cast your mind back over 200 years, long before the current doors of Edison and Tesla, to the feud between two Italian eponyms, familiar to anyone who has ever studied electricity, Luigi Galvani and Alessandro Volta. I wonder if this defib features a full bridge rectifier.
Based in Pavia, Volta -- most famous today for having lent his name to the Chevrolet Volt -- had already established himself as a world leader in the fascinating and still rather new field of electricity. Meanwhile, in Bologna, Galvani -- from whom we get the song "Galvanize" by the Chemical Brothers -- discovered that frogs' legs twitch when electricity is applied to them or even when in contact with certain metals. Volta asserted correctly that the electricity came from the metals used in the circuit and the tasty hors d'oeuvre was merely acting as a conductor or an electrolyte in this case. But Galvani felt the electricity came from within the animal itself, calling this animal electricity, reflecting our primitive early understanding of electricity's role in life. He wasn't entirely wrong. He discovered that muscles were actually acting as sensitive detectors of electricity, something that would lead to the discovery of cellular action potentials.
As the great men of science tend to do, they got into a flame war and Galvani enlisted the help of his nephew, Giovanni Aldini. Aldini was obviously an ardent #animalelectricity supporter and decided to prove this by demonstrating the medical benefit of electricity. He used Volta's voltaic pile, an early form of battery to shock corpses and make executed criminals sit volt, I mean bolt, upright. At Newgate Prison, which used to stand just a few kilometers from where I am now, he applied a current to George Forster, a recently executed murderer.
Giovanni Aldini (read by an actor): On the first application of the process to the face, the jaws of the decreased criminal began to quiver and the adjoining muscles were horribly contorted and one eye was actually opened. In the subsequent part of the process, the right hand was raised and clenched and the legs and thighs were set in motion.
Francis: Soon, reaction videos starting flooding the primitive Internet claiming that Aldini was bringing the dead back to life. In Switzerland, Lord Byron, Percy Shelley, and 19-year-old Mary Godwin were telling each other ghost stories. As her father was pals with Humphry Davy and William Nicholson, Britain's leading electricity researchers, Mary made up a ghoulish tale of a mad scientist reanimating the dead with electricity, drawing directly on galvanism.
Percy clearly found this such a turn-on that within no time Mary and he were married. Two years later, she published Frankenstein, or The Modern Prometheus. Over the subsequent centuries, our understanding of electricity has charged forward with shocking speeds. We all now learn in school how there are electric currents inside cells, how action potentials move our limbs, and how our brain activity is positively grounded in the science of electricity. But perhaps no organ is as strongly associated with electricity as the heart. Just 20 years after the publication of Frankenstein, Carlo Matteucci showed that each heartbeat produces some electrical activity. A steady flow of household names in science and medicine -- Byrd, Bence-Jones, Edison, Kelvin, Duchenne -- all played their part in advancing our abilities and our knowledge in electricity before, in 1887, Augustus Waller, from St. Mary's in London, published the first electrical heart tracing, electrocardiogram, or ECG.
A side note, why are the points on an ECG labeled P, Q, R, S, T and sometimes U instead of the more logical A, B, C, D, E? Willem Einthoven -- the Dutch inventor of the first practical ECG -- did, indeed, use A, B, C, D for the four deflections he initially recorded, but later developed a correct formula, so had to adopt new letters for the derived deflections and used the second half of the alphabet. Continuing a custom started by Descartes to denote consecutive points on a curve, Einthoven started with P. But so far, even though we now had immeasurably greater comprehension of how electricity affects the heart, we had no way of reliably using it to treat anybody.
That is, until 1931, when the first pacemaker, a large unwieldy device, was used. Sixteen years later, surgeon Charles Beck saved a boy's life with two spoons. He had been building on work by William Kouwenhoven experimenting on animals by putting them into cardiac arrest and then shocking them out, until one day a 14-year-old boy arrested during an operation. Out of desperation, Beck sent for his research device and successfully used it to defibrillate the boy. Let's hope he cleaned the fur off first.
Meanwhile, in modern-day Kyrgyzstan, Eskin and Klimov pioneered a new, more powerful defibrillator that would work without the minor inconvenience of having to open up somebody's chest. I had no idea until I researched this video that the USSR had invented a portable defibrillator in 1959. Outside the Soviet Union, the father of emergency medicine -- cardiologist Frank Pantridge, from Northern Ireland -- created the first portable defibrillator in 1965. I say portable, but it was really more of a welterweight. He put it in ambulances and soon the Pantridge plan caught on. It was enthusiastically adopted, especially in America, and just 6 years later in 1972 achieved a high profile when a portable defibrillator saved the life of President Lyndon Johnson after he suffered a massive heart attack in Virginia.
We had now developed options for shocking patients out of lethal cardiac arrest rhythms in emergencies, but we didn't have any solutions for the much more common problem of a heart that just beat too slow. The aforementioned external pacemaker worked for a short-term problem, but many hearts require lifelong pacing and a patient couldn't remain attached to an immobile box. A hero of mine that I've mentioned in a previous video, Walt Lillehei, was operating when a blackout hit Minnesota and he lost his patient because the pacemaker plugged into the mains stopped working. In frustration, he approached Earl Bakken, an electrical engineer with a small company, to try and create something better. Bakken decided to try out this fancy new doohickey called a transistor, allowing him to create the world's first wearable pacemaker and placing his company, Medtronic, on its way to becoming the largest medical device brand in the world.
It's easy to forget just how unbelievable it is that in a short space of time we've harnessed the power of electricity to save lives. From the mysterious force that fascinated Galvani and Volta, to the present day where something like a pacemaker insertion is so routine. It was one of the first skills I learned when I started cardiology training years ago. This device now available weighing just a few kilograms, a far cry from Frank Pantridge's huge portable defibrillator, has saved countless millions of lives the world over. I use it on a regular basis. In fact, I've already used it this shift, and I'm happy to say with a good result.
Decades after inventing the wearable pacemaker, Earl Bakken, then the recipient of two pacemakers himself, would write his memoir explaining how he became fascinated with electricity and its role in creating life. He would pinpoint the exact moment that his interest was peaked to 8 years old, watching a movie in the cinema, none other than the 1931 classic horror featuring Boris Karloff, Frankenstein.
, is an interventional cardiologist, internal medicine doctor, and university researcher who makes science videos and bad jokes. Offbeat topics you won't find elsewhere, enriched with a government-mandated dose of humor. Trained in Cambridge; now PhD-ing in London.