Sir Thomas Lewis ( 1881 – 1945 )

The poor prognosis associated with chaotic irregularity of the pulse was clearly known by most of ancient physicians. Perhaps the earliest description of atrial fibrillation is in Chinese, in The Yellow Emperors Classic of Internal Medicine, but in recorded history, William Harvey in 1628 was probably the first to describe ‘fibrillation of the auricles’ in animals. The first electrocardiographic recording of atrial fibrillation was made by William Einthoven in 1906, in which significant background noise precluded the identification of atrial activity although normal ventricular complexes were seen. Einthoven termed his ECG as ‘pulsus inadequalis et irregularis’ without speculating about the mechanism that caused irregular QRS complexes and chaotic undulating baseline. In 1909 and 1910 Sir Thomas Lewis in London and Rothberger and Winterberg in Vienna independently established atrial fibrillation as a clinical identity. Thomas Lewis, born in Cardiff in 1881, was one of the most important British physicians of his day, a renowned cardiologist and a great pioneer of scientific medicine. He graduated in 1905 from University College Hospital, London with the University Gold Medal, and he worked there for the rest of his life. From the very beginning he was drawn to research, although he was also a clinician, believing that research in the laboratory and at the bedside would help to solve many of the mysteries still confronted by physicians caring for cardiac patients. Lewis focused his investigations on the cardiovascular system. His first cardiac studies were related with sphygmographic recordings in patients with aortic regurgitation. Initially he used polygraph curves to investigate arrhythmias, and later he turned to the analysis of the heartbeat using electrical records from the newly invented electrocardiograph. In 1908 he was able to make use of the first electrocardiograph machine in England that was made in Einthoven’s laboratory. This electrocardiograph was first installed in A. Waller’s department at the Imperial Institute in South Kensington. Lewis obtained his own electrocardiograph, made in Germany, in 1909. In 1911 he replaced his original apparatus with his first electrocardiograph made by the Cambridge Scientific Instrument Company (Fig. 1). In 1908 Lewis recorded an ECG from a patient with a heart block and published it in his first book on arrhythmias. It was while using his first machine that Lewis was able to record rapid irregular arrhythmia as a result of atrial fibrillation (Fig. 2). With the improvement of methods, fibrillatory f waves became clearly visible. Lewis believed that these waves could result only from the fibrillation in the auricle. He noted that the R waves are usually normal in the presence of atrial fibrillation (AF).