1894-1971 Further information on the work of Claude S. Beck Biography
Sudden cardiac death was not fully understood well into the 20th century, despite the fact that once medical care became available and sophisticated enough to eradicate many of the infectious diseases that earlier claimed human lives, heart disease took its modern-day place as significant cause of mortality.
The treatment of those afflicted by sudden cardiac death was nearly non-existent until Claude S. Beck, MD, basing his theories on the work of physiologist Carl J. Wiggers, proposed a specific series of steps for the management of cardiac arrest in the operating room. Wiggers' experimental laboratory work on animals proved that that the maintenance of cardiac circulation by manual massage, followed by electrical defibrillation would restore a normal heartbeat. Beck surmised that these techniques could be used on humans, as well.
Originally trained as a neurosurgeon, Beck ultimately came to Western Reserve University School of Medicine in 1924 following stints at Harvard and Johns Hopkins. At Western Reserve, his interest moved from neurosurgery to cardiovascular research and surgery. From 1925 to 1935, Beck began the exploration of the acute and chronically compressed heart by conducting studies of the physiology of the condition. Those studies resulted in the clinical definitions which came to be recognized as "Beck's Triad".
During that time, Beck also developed a method to deliver additional blood to heart muscle in the presence of coronary heart occlusion which resulted in the Beck I operation (cardiopericardiopexy), which he first performed in 1935. Between 1946 and 1948, he developed the Beck II operation, which consisted of the arterialization of the venous system of the heart by way of the construction of a vein graft between the aorta and coronary sinus, which then stimulated the growth of intercoronary communications. Beck's contributions resulted in significant advances in the area of heart surgery and the pathophysiology of angina pectoris.
Beck is most well known, though, for his groundbreaking work in the defibrillation of the human heart.
In 1947 Beck successfully revived a patient for the first time using defibrillation. He was operating on a 14-year old boy for sternal resection due to a severe congenital funnel chest. Subsequent to administration of anesthesia, the boy developed supraventricular tachycardia and, as was the practice of the day, doses of labatoside C were administered, but had no effect. Cardiac irritability continued throughout the surgery. During the closure of the wound, the pulse suddenly stopped, at which point the chest was reopened and Beck administered manual cardiac massage for the next 45 minutes. At that time, the electrocardiogram showed ventricular fibrillation. Seeing no other choice and using a crude defibrillator he had developed in his laboratory, Beck then applied a series of electrical shocks which resulted in the cessation of the fibrillation. The young boy went on to make a full recovery.
The machine which allowed this remarkable feat was a massive and unwieldy piece of equipment developed by Beck and built by his friend, James Rand of the Rand Development Corp. It used alternating current directly from a wall socket and it required a large transformer, making its size so difficult to move that wheels were added for easier mobility. The silver paddles were the size of tablespoons and the circuit connected the heart to a 110-VA powerline through an ammeter, a switch and a rheostat adjustable to between 10 and 35 ohms. The voltage used was usually 1,000 volts and was applied for one quarter to one half second. At the time, the most significant drawback of the technique was that, since it was not known how much electricity was needed to shock the heart through the closed chest, the metal paddles were, of supposed necessity, placed directly on the ventricles.
This was an auspicious beginning, however, and the age of the defibrillator was born. Shortly after Beck reported his successful resuscitation, defibrillators were placed in operating rooms throughout the Western world, but this is where they stayed for quite some time due to their limited use only on the bare heart. Not until 1956 did Paul Zoll, MD of Harvard Medical School, demonstrate that defibrillation could be successfully performed across the closed chest. From that point until today, the external defibrillator's technological evolution to a small, compact unit with "brains" that tell the user when and how to defibrillate the heart has saved thousands of lives.
Claude S. Beck remained a champion of cardiac resuscitation techniques throughout his career, starting the first CPR teaching course for medical professionals in 1950. In less than 20 years, his course trained more than 3,000 doctors and nurses. In 1964 he was instrumental in an organization, The Resuscitators of America, which taught lay rescue workers the techniques of closed chest resuscitation.
He continued teaching and conducting research at Western Reserve University for the duration of his career and was named Professor of Cardiovascular Surgery in 1952, the first position of its kind in the United States. When he retired in 1965, he was named Professor Emeritus. Beck died in 1971.
Beck's vision of the treatment of sudden cardiac death and his courage to pursue it ushered in a new era of cardiology, starting the technological revolution that has resulted in both the external defibrillators and internal cardiac defibrillators (ICDs) of today. Although the causes of sudden cardiac death remain, to some extent, a mystery, the development of the defibrillator has saved thousands of lives since that significant day in 1947.
Photo courtesy of Dittrick Medical History Center of Case Western Reserve University.
