Intended for healthcare professionals

Endgames Christmas 2022: Brain Stew


BMJ 2022; 379 doi: (Published 19 December 2022) Cite this as: BMJ 2022;379:e074083
  1. Patricia McGettigan, reader in clinical pharmacology and medical education1,
  2. Ian C Cooper, retired consultant cardiologist2,
  3. Jennifer H Martin, professor of clinical pharmacology3,
  4. Anne-Marie Schjerning, cardiology fellow4 5 6,
  5. Robin E Ferner, honorary professor of clinical pharmacology7
  1. 1Centre for Clinical Pharmacology and Precision Medicine, William Harvey Research Institute, Queen Mary University of London, UK
  2. 2107 Pall Mall, London SW1Y 5ER, UK
  3. 3Centre for Drug Repurposing and Medicines Research, University of Newcastle, Hunter Medical Research Institute, NSW, Australia
  4. 4Department of Cardiology, Copenhagen University Hospital–Herlev and Gentofte, Copenhagen, Denmark
  5. 5Danish Heart Foundation, Copenhagen, Denmark
  6. 6Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
  7. 7School of Clinical and Experimental Medicine, University of Birmingham, UK
  1. Correspondence to: P McGettigan p.mcgettigan{at}

Because a physician has possessed himself of an electrocardiograph, a polygraph, an x-ray machine, a blood pressure instrument, or some ingenious form of stethoscope, it does not at all follow that he has become competent to judge a patient’s condition; not infrequently the very reverse is the case, for more often than not the limitations of these devices are far from being comprehended.

Thomas Lewis, British Medical Journal 19191

In 1912, the then British Medical Journal published Thomas Lewis’s work entitled “The electro-​cardiogram and its importance in the clinical examination of heart affections.”2 His recording apparatus was enormously cumbersome compared with today’s sleek machines (fig 1), but, remarkably, he could record amplitude in the range of 0.1 millivolts. Lewis’s classic representation of the normal PQRST complex is still instantly recognisable over a century later (fig 2).12

Fig 1

A subject connected for observation of the electrocardiogram.3

Fig 2

A normal trace on an …

View Full Text

Log in

Log in through your institution


* For online subscription