About the Cover
The first half-century of echocardiography
Alan G. Fraser
Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff. CF14 4XN. Wales, UK
In 1953 Hillary and Tenzing climbed Everest, and were feted with tremendous acclaim around the world. In comparison, two landmark developments in medicine were hardly noticed, but their subsequent impact has been immense. Watson and Crick identified the structure of the double helix, but arguably an equally great contribution to medical practice was the development of echocardiography.
The pioneers of echocardiography were Inge Edler (1911-2001) and Hellmuth Hertz (1920-1990)1. In 1953 Edler was a physician in the cardiology department at the University Hospital in Lund, where he was concerned at the poor and unpredictable outcome from mitral valve surgery. In the hope of developing some non-invasive imaging technique for studying his patients with rheumatic valve disease, he approached Hertz 2, who was a graduate student in physics.
Hertz went to the shipyards in Malmö and experimented with an ultrasound reflectoscope that was used for testing metals. He obtained some moving signals, so he arranged to borrow a machine that he and Edler then used to study patients over a weekend in May 1953. Unknown to them, others had already experimented with transmitted ultrasound for medical imaging with discouraging results, but Edler and Hertz used reflected ultrasound and they were perhaps fortunate that the machine that they borrowed from the shipyards operated at a frequency that was appropriate for cardiac imaging. They were encouraged by again obtaining moving images, and so later the same year they were lent a machine by Siemens for their own use.
They started their systematic studies in October 1953, calling their technique ultrasound cardiography (or UCG). Hertz constructed a camera for recording M-mode traces (he was later also to develop ink jet printing), and they started to obtain signals probably from the anterior mitral annulus, the left ventricular posterior wall, and the ventricular septum (figure). Later they undertook detailed comparisons of the ultrasound signals and cardiac anatomy, by which they established the basis of echocardiography. They published their first paper in the proceedings of the Royal Physiographic Society in Lund 3, in 1954.
Edler and Hertz were nominated for the Nobel prize for medicine, and maybe if they had not been Swedish they would have been given this award. Nonetheless they both lived long enough to witness enormous advances in technology and clinical research in the field of echocardiography that they had initiated, and to know that their first steps led to enormous benefits for patients, through rapid and precise diagnosis and thereby appropriate and effective treatment. In later life Edler declined to speculate on developments in cardiac ultrasound, but he was quietly gratified that they continue apace.
Figure legend
Upper Panel: Inge Edler (right) and Hellmuth Hertz (left) with their first Siemens machine that they used for the first studies of echocardiography in 1953; this machine is now in the Medical Historical Museum in Lund, Sweden. Photograph courtesy of Professor Kjell Lindström, University of Lund. Lower Panel: Two traces from the first black and white film of M-mode echocardiograms, recorded by Hertz and Edler on 29th October 1953. The original film was given by Professor Edler to the Working Group on Echocardiography of the European Society of Cardiology.
References
1. Lindström K. Carl Hellmuth Hertz. Ultrasound Med Biol 1991; 17: 421-424.
2. Fraser AG. Inge Edler and the origins of clinical echocardiography. Eur J Echocardiogr 2001; 2: 3-5.
3. Edler I, Hertz H. The use of ultrasonic reflectoscope for the continuous recording of the movement of heart walls. Kungl Fysiografiska Sällskapets i Lund Förhandlingar 1954; 24: 40-58.
[Table of Contents]
