The electrocardiograph was the first cardiological investigation introduced into Wellington Hospital, and it remains the most commonly performed.
Around 30 years after the hospital acquired its first ECG machine, the ECG as a continuous monitoring tool was introduced into hospital practice in the cardiac catheterisation laboratory and in operating theatres.    Subsequently the monitored ECG became widely used in the special units - CCU, ICU and NNU - and in the A&E, exercise laboratory, and in many other hospital environments.

ECG Equipment

A Cambridge electrocardiograph, similar to the one pictured, was installed in the cardiology department in 1926.  Movements of the string galvanometer were captured photographically.  The patient was connected by way of immersing three of four limbs in containers of saline solution - one of my elderly patients was able to recall this experience.
Clearly this was not portable.  When Fred Bowerbank took delivery of the equipment, he replicated what he had seen when visiting the National Heart Hospital in London.


At the National Heart Hospital, in-patients too ill to go to the basement where the ECGs were recorded, had their limbs connected by way of saline pads to wires which ran from the wards down to the ECG room.


At Wellington Hospital, an electrician, C. W. Bland, connected certain beds in medical wards 5 and 6 with suitable wiring to the Cardiology Department which was nearby.





A string galvanometer machine with photographic records was still in use in 1953, but had largely been superceded by the Sanborn VisoCardiette direct writing portable electrocardiograph, first used at Wellington Hospital in the 1940s.

Charles Burns recalled that you had to carry batteries with you when using this machine.












In 1961, the Sanborn Company was acquired by Hewlett Packard who continued the manufacture of ECG machines.   Shown is the HP 1500A machine introduced into Wellington Hospital in 1964.  It was much lighter than the VisoCardiette.










In 1974, the first 3-channel electrocardiograph, the HP 1515B was acquired.  This required all ECG lead positions to be connected and produced a 12-lead record on a single sheet of wide recording paper.










A major advance was the availability of the first computer-based page-writer electrocardiograph, such as the HP 4750A shown here.   This was acquired in 1985 and for the first time, a single page of the 12-lead ECG was produced on robust paper suitable for filing without any need for further processing. 
In addition, copies of the ECG record could be printed without having to make another recording.








By the 1990s, ECG machines came with a preview screen so that the user could check the quality of a recording before accepting for printing.
One such machine used in the Cardiology Department was the HP Pagewriter XLI, seen here.











Shown here is one of the ECG machines in current use in the Clinical Measurenet Unit.







ECG Processing

The original ECGs recorded using a string galvanometer were captured photographically.   The photographs were processed in a dark room and the prints cut into narrow strips which were pasted on to a card, or in later years, mounted using staples.

This ECG was recorded in 1955, and was probably one of the last photographic tracings made.


With the acquisition of the Viso Cardiette electrocardiograph, came a major advance in ECG processing.   No longer was a dark room required.  The paper output was marked to label each ECG lead sample, and the unmounted ECG was attached to the request form and placed in a basket for reporting.


Before mounting, selected examples of each ECG lead, together with a sample of continuous record (for rhythm), were laid on heat-sensitive glued paper.  Then, a warm iron was applied to activate the glue and thereby fix the mounted ECG samples.



This was a very time-consuming process, and in the 1970s a clerk was employed to assist in mounting, thus freeing the technicians for other duties.  One such clerk was Val Burke, pictured left.









In 1977, Betty Cosgrove joined the staff in this role which also included answering phone calls to the technicians' work room.   During Betty's tenure, double-sided sticky tape became available and the cumbersome mounting irons were consigned to history.  Betty retired from the Cardiology Department in 1990.









With the acquisition of a 2-channel electrocardiograph, some processing time was saved by having paired leads printed simultaneously.

Once pagewriter ECG machines came on the scene, mounting of ECGs was no longer required.


ECG Reporting

Fred Bowerbank would have reported all the ECGs done during his tenure.
In 1948, Charles Burns observed that the number of ECGs being done had significantly increased and that he spent the equivalent of one half-day each week reporting them.   He was not being reimbursed for this work.

Eventually there was recognition of the time spent reporting ECGs and by the early 1960s, four physicians (Drs Hallwright, Hall, Todd and Luke) were each paid for one ECG reporting session/week.
ECG reporting was always something of a chore, not helped by the lack of clinical detail supplied by the requestor in some cases.   Some of the reporting physicians collected the large pile of ECGs at the end of the day, took them home for reporting, and returned them the following morning.  Others, such as Frank Hall preferred to report the ECGs in the Department during the evening.   On more than one occasion I remember well attending the department during the evening when on-call and finding Frank Hall fast asleep over a pile of ECGs at his desk!

With the arrival of full-time cardiologists, Ponty Hallwright was the first to be let off the ECG reporting hook.
During the 1960s and 70s, all ECGs recorded in the hospital, including those done on ECG machines based out of the Cardiology Department, were required to be reported by cardiology staff.  There was subsequently a move toward general and other specialist physicians and their registrars reporting ECGs on their own patients.  Eventually, cardiology staff reported only ECGs from surgical wards, the Emergency Department and those requested by GPs.


Ambulatory ECG Monitoring

The first Holter monitoring equipment was acquired in 1979.  It was an Oxford Medilog, tape-based system which provided limited display of rhythm abnormalities on a very small screen, and an ECG strip needed to be printed out for each suspected abnormality.


The second Holter recording system was acquired on 31/10/1984, financed in part by a generous grant from the Watson Trust.
The total cost of the Oxford Medilog equipment was $33,000.  In the photograph below are Charge Technician Gwen Turner and Technician Vikky D'Ath with a patient.

This new Holter system was a big improvement over the first in that the analysis screen was large and full rhythm strips could be viewed.


The Oxford Holter monitoring system proved to be a useful tool though problems with malfunctioning of the tape system were not infrequent.
In 1992, a Del Mar digital system replaced the Oxford tape-based equipment, and no longer were there any problems with tapes sticking.  In addition, the analysis software was more sophisticated.




Here Technician Susan Brady explains the procedure to a patient.








Technician Talia Canvin analysing a 24-hour recording acquired with the new system








A newer Del Mar Holter system was acquired in 2008, with smaller patient recorders and an improved digital recording system.












In 2001 the first implantable ECG recorder was used - the Medtronic Reveal.

In the years 2008 - 2010,
13 - 15 of these devices have been implanted annually.

They have been especially useful in patients with infrequent syncope.  Later models may last as long as two years.


Stress Testing

When I was a registrar in Cardiology in 1965, the Master's Two Step exercise test was still being done.   The patient was hooked up to an ECG machine, a resting ECG was performed, and the leads then removed, leaving the electrodes attached.  The patient was then asked to step up and down on a simple two step as quickly as possible to elevate the heart rate.  When it was deemed that sufficient exercise had been done or symptoms developed, the patient was asked to lie up on the couch and the ECG leads were re-attached.    Another ECG was recorded and generally the heart rate was still elevated.
There was no ECG monitoring during exercise and no standby defibrillator available.

In the early 1970s, a small number of exercise tests were performed in the Respiratory Lab, using either a bicycle ergometer or treadmill.  Years later, when the bicycle was deemed to be redundant, it was donated to the Nuclear Medicine Department for gated heart scans.

Eventually, Cardiology acquired their own treadmill and as there was no space to house this in the Department at the front of the hospital, a small room was used at the top of the ramp corridor to the 210-block.
In time, the Neurology Service vacated several rooms off the corridor connecting the main hospital corridor with Cardiology.   What had been Dr Jack Bergin's office was converted into the treadmill room.

Around 1990, a new treadmill replaced the old.  Improvements included the ability to programme timed recordings and a better single-cable ECG connector to the treadmill console.

This treadmill was used for standard stress assessments, some stress nuclear studies and for some of the early stress echo tests.   The old treadmill was moved up to what had been a storage / property room behind the Cardiac Care Unit in the WSB.  This was conveniently sited for assessments of inpatients.   The new equipment was moved to the CSB 11th floor site when the Department temporarily moved there in 2003.


In July 2007, a new treadmill was installed in one of two stress-testing rooms in the Clinical Measurement Unit.

Last updated 8 October 2021.