Ventricular fibrillation and defibrillation: historical perspectives with emphasis on the contributions of John MacWilliam, Carl Wiggers, and William Kouwenhoven.

ALTHOUGH palpation of the pulse has played an important role in the evaluation of patients since antiq- uity, insight into the relationship of cardiac arrhyth- mias to syncope did not develop until the 19th cen- tury.'Among the critical developments that led to an appreciation of the significance of cardiac arrhythmias were the introduction of instruments that permitted graphic registration of the heart beat and accurate quantification of intravascular pressures.These instru- ments were used in animal experiments that led to a gradual recognition of the clinical manifestations of cardiac arrhythmias and their role in sudden death.Two major stimuli were responsible for a renewed interest in resuscitation during the final quarter of the 19th century.They were the growing concern about unexpected sudden death during chloroform anesthesia and the electrification of urban society with its resul- tant danger of accidental electrocution.A relatively sophisticated understanding of the na- ture of electricity had developed during the late 18th and early 19th centuries through the efforts of Luigi Galvani, Alessandro Volta, Michael Faraday, Joseph Henry, and others.2Enthusiasm for using electricity as a therapeutic modality grew steadily during the 19th century, and by midcentury several European medical scientists were exploring the effects of electricity on experimental animals and man.3In 1850, Carl Ludwig, the pioneering German physiologist and inventor of the kymograph, demonstrated with his pupil Hoffa that it was possible to induce ventricular fibrillation in