Summary of Career—In George’s own words:
George Johnston – a Profile in Clinical Engineering (1996)
"My entry into the field of clinical engineering came shortly after graduation from high school in 1948 when I gained employment as a medical electronics technician at the Johns Hopkins School of Medicine. Perhaps it was fortuitous that I was unable to afford full-time college tuition and scholarships which at the time were reserved for returning World War II veterans. Thus, I plugged away part-time at night school in electrical engineering at Johns Hopkins for eight years until I graduated in June of 1955. Although electronics had been my interest since the age of 12, the Hopkins electrical engineering curriculum at that time, like that of most colleges, was power-oriented. Only two courses even touched on electronics. What electronics I did learn was learned on the job at the Medical School. Life sciences knowledge was similarly obtained on the job. The EE curriculum included a wide range of non-EE courses like thermodynamics, statics, dynamics, and strength of materials. These were not my favorite courses, and my grades showed it. However, I have since found every subject useful in my biomedical engineering design work.
After eight years at the Medical School, I knew I wanted to stay in academia, but following graduation I still had to satisfy my two-year military obligation. Again, I was fortunate. Knowing that time in the Public Health Commissioned Corps would satisfy my military obligation, with my experience and new BSEE, I landed a job as Biomedical Engineer in the Corps at the Instrument Section of the National Institutes of Health. My colleagues predicted I would become a permanent government employee, but I knew that after two years I would seek a university position. At NIH I authored my first publication and presented at two engineering conferences. After two years and nine months, more excellent on the- job training, and design experience, I left to start my own biomedical engineering support department at the University of Oregon Medical School (now Oregon Health Sciences University).
I modeled my department, which I named Research Instrument Service, after the NIH's Instrument Section and JHU's School of Medicine shops where I had obtained my early experience. Mine was one of probably less than a dozen such departments in the country at that time. We provided design, fabrication, and maintenance of both research and clinical equipment. Because many scientific instrument companies had yet to develop extensive maintenance service, we became contract Pacific Northwest maintenance providers for several of them. My maintenance experience by this time had convinced me that no engineer should be turned loose to design anything until he or she had served a full maintenance apprenticeship, something I still believe.
As research grant money became increasingly available during the '60s, our design and fabrication activities grew correspondingly and we added a glassblowing section to our department and later a computer section, the University's first computer service. During this time, we developed several instruments of commercial worth, obtained one patent, and published or presented more than twenty technical papers on our activities.
In 1967 three of us, Jay Yowell, Bob Morris (who I hired in 1964 to become my assistant director and who was the major contributor to our technical successes) and I presented papers at the 7th International Conference of Medical and Biological Engineering in Stockholm, Sweden. At the meeting I met Torsten Rudjord, a Norwegian biomedical engineer from the University of Oslo's Neurophysiological Institute. Encouraged by Torsten, I applied for a fellowship from the Royal Norwegian Council for Scientific and Industrial Research. Successful, I spent a sabbatical year at the Neurophysiological Institute during 1970-71. My first international experience and a glorious one at that! During the 1970s Federal emphasis turned from the research arena to the clinical arena. The government wanted all those marvelous devices developed with research dollars to be translated into clinical devices providing better patient care. My department, like many such departments, experienced a significant shift in customer base from research institution to hospital. Within ten years we became a hospital department and changed our name to Clinical Engineering, to reflect our current activities. About that time, through Bob Morris, I learned about Project HOPE and filed a CV with them. I heard nothing from them for several years until June of 1983, when I received a call asking if I could help teach medical equipment maintenance in Jamaica. My wife and I spent our month's summer vacation in Kingston where I was able to "kluge" together a semblance of a maintenance shop in the HOPE warehouse and put six of the first biomed graduates from the College of Arts and Sciences to work on repairing an enormous backlog of equipment. My relationship with HOPE prospered and the following year I spent a month putting in a maintenance shop at the Cornwall Hospital in Montego Bay, Jamaica. The next year, it was a month in Krakow, Poland reviewing the maintenance facility at the Children's Hospital. Then on a University contract with the U.S. Treasury Department, I spent a month in 1988 at the King Abdul Aziz Medical School in Jeddah, Saudi Arabia designing a medical equipment support facility.
The overseas experiences were both trying and a delight for my wife and myself, so much so that I retired from the University at the end of 1988 after thirty years and took a long-term (one-year) assignment with Project HOPE in China setting up clinical engineering education and training programs. A recount of our experiences there appeared in the Journal of Clinical Engineering, Vol. 17, No. 6, 1992. That experience was followed by a similar, although not nearly as productive a year with another organization training nine BMET's and setting up a maintenance facility in Guyana, South America. The disasters associated with that program are alluded to in another Journal article: "Problems, Perils, Precautions and Rewards in Overseas Clinical Engineering Training, Vol. 21, No. 1, 1996." Since then, the variety of overseas consulting activities has expanded. I spent two six-week periods in Cairo, Egypt for EduSystems helping to develop electrical and electronic instrumentation maintenance courses for water and wastewater treatment plant engineers and technicians. Most recently I put on a three day course on Logical Troubleshooting for engineers and technicians in Kuala Lumpur, Malaysia for Management Engineering Associates. That was so successful that I have been invited to repeat it in the fall. Lately, despite my being approached on a number of overseas possibilities, nothing seems to have materialized. However, I am able to keep busy on some domestic consulting. People keep asking me when I intend to retire. I answer, "I would rather wear out than rust out."
A Wiki History of Medical Technology (George Johnston’s perspective, 2012)
During the 2012 AAMI meeting I was sitting with some "old timer" clinical engineering colleagues (of which I am the oldest of course) having our-end-of-day cocktail and discussing the aging of ACCE and the growing loss of ACCE history. I had suggested some years ago that ACCE should establish a position of archivist, as I had begun to note how often those of us who were long term or founding members, were being asked for specific bits of historical data. We agreed that it was time to develop a written history of ACCE and perhaps maintain it as a journal. One friend commented that by now it was unlikely that any one member would be able to recall all the details and events associated with the founding and growth of ACCE. So another suggested that perhaps we could take the "WIKI" approach where a first cut write-up could be circulated through the ACCE Newsletter with an invitation for members to fill in missing details from their recall. We suggested that Tom Judd, currently chair of the Advocacy Committee and one of the colleague’s present, take the initial action of getting that started. It then occurred to me that I and a few other "old timers" have long had an interest in gathering historical data on early medical technology and even written a few articles on the subject. Perhaps the WIKI approach might be a good way to develop a truly comprehensive history of the evolution of medical technology.
So here is my start.
1948 – 1958 Through George’s eyes
I was fortunate to obtain a job in January 1948, six months out of high school, as a "medical electronics technician" in the Johns Hopkins School of Medicine. I was hired to work in one of a number of small departmental shops located throughout the Johns Hopkins Hospital complex. This one established by Dr. Samuel A. Talbot and managed by Ed Pride. Considering my age and minimal; experience, I was probably hired because I had become acquainted with Dr. Talbot as a small boy visiting my grandfather’s shop in Johns Hopkins Hospital’s Wilmer Institute back in the 1930’s when Talbot was doing postdoctoral biophysical optics research and needed my grandfather’s assistance to construct some specialized instrumentation he required.
In the post WW2 period of the 1940’s commercially available instrumentation for diagnosis or treatment were quite limited. There were two choices for EKGs, Sanborne or Cambridge. Two choices for EEGs, Grass or Eden. Diagnostic x-ray and x-ray fluoroscopy were primitive and hazardous, especially by today’s standards. The turn of the century Bovie spark gap electrosurgical had evolved to a "modern" vacuum tube model. And psychiatrists had a primitive and potentially hazardous electroconvulsive therapy devise, which has periodically been in and out of favor ever since.
Clinical laboratories had the Beckman and Coleman spectrophotometers, the Beckman and Cambridge pH meters and Klett Colorimeters. Those are the major instruments of which I remember and which I used to moonlight repairing.
However, a lot of advanced electronic and vacuum tube technology developed during WW2 had yet to be exploited by commercial manufacturers to provide a larger and more varied choice of medical instrumentation Hence much early development was accomplished in medical university maintenance and repair shops. A few medical universities had centralized biomedical support shops like UC San Francisco’s R&D Lab (Research and Development) founded under the directorship of Carter Collins somewhere in the early to mid 1950’s. Most medical universities had small departmental shops like those at Johns Hopkins. The shop I was hired into, in Johns Hopkins University’s Department of Medicine, was like many in research hospitals and universities throughout the country, was busy building customized electronic research devices. At the time we had an order for a number of "delay units." These were variable pulse generators used by researchers to stimulate nerve and muscle tissue for myoelectric investigation. One of the engineers in the shop was also designing and building an early two-beam oscilloscope for another Department of Medicine researcher, utilizing Dupont’s newly developed 279 cathode ray oscilloscope tube which had TWO complete sets of cathodes and deflection plates. Thus the display could simultaneously show a fast nerve impulse response and a slower mechanical muscle contraction on a single sweep.
Once the order for delay units was filled, I was transferred to a research group doing investigation on the treatment of myasthenia gravis. The delay units were part of the instrument system used to study the nerve-muscle response to electrical stimulation on patients with myasthenia gravis who experience early fatigue and debilitating muscle weakness with minimal activity. The research was supported by a contract with the Army Chemical Warfare Service who also supplied the nerve gas compounds used to experimentally treat the disease. The instrument system was mostly made up of custom units from small private builders much like the delay units. The stimulus amplifier and audio system were also constructed at Hopkins. The low level physiological amplifier was from Grundfest and constructed on a Plexiglas chassis suspended on springs to minimize ground currents and microphonics. The oscilloscope was a Dumont 279 two beam scope which allowed presentation of the fast muscle action potential response against the slower physical muscle response recorded from a strain gage. The oscilloscope nerve/muscle response image was captured on a Grass kymograph camera. Grass Instruments was one of the earliest companies marketing a variety of electro-medical devices for both research and clinical diagnosis. I was the technician operating the equipment. I would run a series of ulna nerve stimuli, recording the action potentials from the palm muscles downstream and the muscle contraction strength from a strain gage attached to the palm. These potentials would be presented on the oscilloscope and recorded on 35-millimeter film by the Grass camera. Later Dr. Grob would administer a nerve gas compound intraarterially while I was running a second set of nerve and muscle stimuli to be recorded and later compared against my first set to determine the effectiveness of the compounds.
About this time I became aware of Tektronix and its 160 series pulse and waveform generators in addition to its main line of oscilloscopes. And I realized the 160 series could even better perform the neuro-physiological stimulus function we had been accomplishing with our inhouse designed and fabricated product. This was the beginning for commercially available devices with newer electronic technology. And over the next thirty years I discovered Tektronix 160 series units in medical research laboratories throughout the world along with Tektronix oscilloscopes and low-level amplifiers.
With the war over and technology developed during the war becoming available to civilians, researchers everywhere, especially in medical research facilities, were taking advantage of these newly developed technologies, employing in-house technical groups, often using returning veterans with technical expertise, to design and fabricate unique instrumentation to facilitate their research. At Hopkins Talbot had several groups working on the development of instrumentation to study cardiac activity from both a physical and electrical perspective; developing several versions of the ballistocardiograph and other versions of the vector cardiograph. Another of his technicians had learned to pull glass microelectrodes and fill them with a conductive salt solution enabling the examination of single cell electrical activity using high impedance low-level amplifiers developed at another institution. One such amplifier was the Bak negative capacitance amplifier developed by Tony Bak, a technician at the National Institutes of Health. This was a clever circuit employing a driven inner shield minimizing the input capacitance to the amplifier thus offering a better high frequency response for action potentials. The newer vacuum tube technology developed during the war also enabled the design of amplifiers that have lower noise levels and higher input impedances suitable for recording the millivolt nerve cell signals detected through the high impedance glass microelectrodes and the microvolt muscle action potential signals from surface electrodes. These were exciting times!
Talbot was in contact with three other biophysicist, Herman Schwan at the University of Pennsylvania, Otto Schmitt at the University of Minnesota and Kenneth Cole at the National Institutes of Health. They not only consulted and collaborated on instrument development ideas they each had an interest in assuring the recognition of biophysics as an academic discipline, leading to the formation of the biophysical society in 1956 and also pushing for the development of biomedical engineering.
During my years at Hopkins (1948-55) I observed several of Talbot’s engineers, George Web, recruited from the University of North Carolina, Tom Arnold, Harry Johnson and George Edlen from Bendix Radio in Towson Maryland, Kirby Harrison a newly graduated mechanical engineer and Jake Beezer a returning air force electronics specialist (and the only person to fly both atomic bomb missions over Japan) designing among other things, both stiff and floating versions of the ballistocardiograph bed to measure the external physical impact of heart action. The first floating bed was a mercury bed, but when they decided mercury was too hazardous, they went to a water bed and finally to an air bed (forerunner of air hockey). They were also working with another cardiology group on various vector cardiographic recording and analysis systems. They developed some very sophisticated frequency analysis systems to further analyze the components of the vector cardiographic signals. Some of Sam’s people also worked on instrumentation for the breakdown and analysis of EEG signals and acquired one of the Eden EEG spectrum analysis instruments. Another group in the department of medicine, in another small shop around the corner from mine, had developed and were manufacturing and marketing an early ear oximeter developed there (forerunner of today’s pulse oximeter). In the Hopkins Hospital and Medical School complex there were a number of small departmental shops providing support to departmental researchers. As I mentioned earlier my grandfather operated one in the basement of the Wilmer institute. Radiology had another one. The School of Hygiene had one in its basement. In lieu of a full-blown shop many researchers hired an engineer or technician to provide needed technical support such as I was providing Dr. Grob. Other large medical universities were doing much the same. But the first large centralized shop I am aware of was the Research and Development Laboratory (known more simply as the R&D Lab) at the UC Medical School in San Francisco, I mentioned earlier. I believe it was Dr. Stewart McKay who pushed for it and Carter Collins was its first director. I believe Carter left to pursue a PhD and Emil Barrish became its next director. Emil and I became good friends in later years often rooming together when we attended annual biomedical engineering conferences.
One day at lunch with another technician friend, he told me he had spent a weird morning with a crazy professor from the Johns Hopkins Homewood campus by the name of Kowenhoven. They had spent the morning pulling cadavers out of the morgue and making body impedance measurements. Neither of us knew at the time this was the Kowenhoven who would father the defibrillator; work supported by a grant from the Baltimore Gas and Electric Company.
During my years as the operating and maintenance electronic technician in Dr. David Grob’s research group I became acquainted with Dick Johns, a resident physician with a physics background. He worked with us part time and contributed several ideas to the improvement of our instrument system and operational technique. Earlier Dick worked for Sam Talbot during a break in his medical school years and discovered their mutual interest in biomedical engineering. Dick went on to take Sam’s early biomedical engineering program into a fully recognized graduate program at Hopkins in 1958; one of the first in the country.
During my seven years at Hopkins I attended night school at Hopkins Homewood campus pursuing a degree in electrical engineering. I graduated in June of 1955 and was fortunate to obtain a job at the National Institutes of Health (which also satisfied my military obligation of that time - Korean War) in what was then simply known as the Instrument Section, but later to become the Biomedical Engineering Development Branch. The Instrument Section was a well-organized technical support facility able to provide all types of instrument repair as well as design and development of original instrumentation for the various institutes researchers. The shops consisted of a machine shop, glassblowing shop and electronics shop all headed up by an engineering design and development group. The work consisted of about fifty percent repair and fifty percent design and fabrication of new instrumentation for the many research groups in the various institutes. One of the first projects I became involved with was the evaluation of an extracorporeal pump for open heart surgery (an evolving technology in cardiac surgery in the mid 1950’s). They had acquired a pump manufactured in England that employed paddles that squeezed the tubing carrying the blood in a manner which produced a pulsatile flow much like that of normal heart activity. The question being asked at the time was whether pulsatile flow was necessary or would continuous flow from a much simpler rotary pump be just as effective? The department engineers proceeded to design a rotary pump to be fabricated in the machine shop and employed in a comparison study. The rotary pump was found physiologically satisfactory, much simpler to fabricate and operate and thus became the standard design for all future heart-lung machines.
During my three years at NIH I gained enormous experience in instrument design at a time when new technologies including transistor technology were blooming. I had already acquired considerable experience servicing many battery powered medical devices. I had also acquired considerable vacuum tube and semiconductor technology experience which lead me to develop line-operated power substitutes for many battery voltages; particularly the filament voltage for the RCA 5734 movable anode transducer widely employed by many research neurologists and physiologists. A very simple transistor emitter follower employing a Zener diode reference did the trick for needed filament voltages. And VR tubes which I had seen employed in many devices designed and constructed at Hopkins did the trick for higher battery voltages. My first paper on these circuits to eliminate batteries was published in the Journal of Applied Physiology in 1958. When I was hired at NIH I was the only "electronic" engineer. My boss was a power engineer with little electronic knowledge and the department head was a mechanical engineer (and also an early airmail pilot). But also as the "young" new kid on the block I was tested by the shop people and also assigned to an irascible doctor needing some equipment design and who nobody in the shop wished to deal with. Turns out the doctor simply knew what he wanted and the shop people failed to give him credit and listen to him. I drew the plans for his equipment control system and after the shop people fabricated it AND it worked to his satisfaction we became good friends and I passed the test with the shop people. I was also gratified to learn that he, Dr. Wilton Earl, became a world-famous pioneer in tissue culture. And I had had the privilege of working on the design of his instrument system.
Another colleague from Hopkins completed his PhD there and joined NIH the same summer I did. He joined Dr. Stanley Sarnoff’s cardiology team in the Heart Institute developing cardiac repair techniques. In addition to experimental surgery on beating dog hearts they were also implanting caged ball valves in aortas. The ball valve was developed by a Dr. Hufnagel and consisted of a caged acrylic ball working against a Teflon seat. My friend, Wendell Stainsby took one of the collies with an implanted valve home as a pet on which he could follow its continuing health. I often played bridge at his house and could hear the dog "clicking" away while lying on the living room floor. The dog continued to exhibit good health as attested by the delivery of three puppies. This was the beginning of the artificial heart valve era. I was working on some equipment in Sarnoff’s laboratory one time when he wondered in to chat. He commented that he never understood all that electronic stuff, but his brother did. It didn’t dawn on me until days later that his brother was David Sarnoff, then president of RCA.
I did considerable work with a Chinese neurophysiologist. Dr. Cho Lu Li. We made some small passive radio frequency receivers implanted in the abdomens of primates with leads extending up to electrodes placed on motor cortex areas. Then with the primate strapped in a chair we would beam an rf signal at him to observe the muscular response. Later he requested a more sophisticated stimulating and recording system similar to the one I had worked with at Hopkins. This time I was able to employ the Tektronix 160 series pulse and waveform generators I had become aware of while at Hopkins. Li, like many researchers I had worked with over the years, was something of a character. He was banned from the NIH animal quarters for teaching some of the primates to smoke cigarettes.
NIH, being a government agency, could avail itself of resources beyond the reach of public bodies. At this time isotopes were being used to scan for thyroid tumors using a photomultiplier with a lead collimator. What is better than lead for focused collimation? Gold. Some thirty thousand dollars of gold was acquired from the Philadelphia mint to machine two collimators for a dual isotope scanner to be used in a research project. The shop director and assistant director actually drove to Philadelphia to pick up the gold. On the way back they were caught in a traffic jam in Baltimore which significantly elevated their anxiety until they made it through. The machining was done in a separate room with a shotgun guard posted outside. And each day all of the gold chips were collected. My involvement in that project was the design of the motor driven scanning system.
1958 – 1968 Through George’s eyes
My years at Johns Hopkins convinced me to stay in the academic (university) field and my years at NIH determined my profession to be biomedical engineering. While vacationing in Oregon the summer of 1957, I visited the University of Oregon Medical School. I had learned a former NIH researcher was now on the faculty of the University of Oregon Medical School and decided to look him up. Interestingly enough it was at a time when the Medical School research faculty had an interest in establishing an in-house instrument support facility (they were as yet unaware of the term biomedical engineering). They had been receiving some support service from a few local artisans and volunteer service from local industry, particularly Tektronix and Electro-Scientific Industries. The presidents of both of those companies had a soft spot for medical research and the president of ESI had been a former Beckman Instruments design engineer responsible for the design of the Model B spectrophotometer. An all-electronic (no batteries) step up from the DU and employing Raytheon’s newly developed sub-miniature vacuum tubes. But local repair service for most commercial instruments was unavailable, often requiring instruments to be shipped as far away as San Francisco or Chicago.
My credentials, seven years as a Johns Hopkins medical electronics technician, a Johns Hopkins electrical engineering degree, and three years as a biomedical engineer at NIH must have overwhelmed them because I was promptly offered a faculty position to establish an instrument support operation at the University. In fact I was asked to start right then. I accepted, but with NIH obligations I was unable to start until the following May.
Upon arrival in May of 1958 I had to design the shop layout for the space provided, order all machine tools, test equipment, parts and supplies. I modeled it as a miniature NIH instrument section with a machine shop, electronic shop and engineering section, all in all in 800 square feet of space. Later when we moved to larger space I was able to add a glassblower. I was able to get the shop up and running and hire my first technician by July. One of the first project requests that summer was from a local obstetrician (not a Med School person) caring for a pregnant diabetic woman. Seems she had already miscarried twice. His desire was to get the woman at least through the seventh month but wanted a way to monitor the fetal heartbeat and determine when the baby was in distress. Then he would promptly perform a Caesarean. Monitoring then was done by paper strip recorders. Obviously, we could not record continuously for days on end. I was able to rig two Microflex timers to control the sample frequency and sample time. The system worked and the doctor was able to determine the beginning of fetal distress and deliver a healthy baby.
By the end of 1958 I had acquired two machinist, two electronic technicians and an engineer all kept busy with both repairs and requests for original instrument development. In 1960 construction was started on a new Research Building. We were able to move into 2200 square feet in that building in the fall of 1962.
The University of Oregon Medical School had a number of imaginative research and clinical faculty. In the fall of 1959, I was approached by a cardiac surgeon experimenting with artificial heart valves. Dr. Albert Starr and a local engineer, Lowell Edwards, working with him, were experimenting with a mitral valve replacement in dogs. But none of the dogs survived for more than two hours. The valve consisted of two hinged flaps and the problem was that blood pooling around the hinge clotted and eventually blocked that valve action. I suggested to Starr that they use a caged ball valve like that developed by Hufnagel at NIH. He asked that we build him one. After he implanted that one he came down to delightedly report that the dog had survived for EIGHT hours. And at that point Edwards started making ball valves for him which eventually were marketed as the Starr-Edwards mitral valve replacement. Made Starr famous and both of them a fortune, I’m sure. More companies were expanding their activity in the health care field and new companies were entering the field. Frank Offner, an electrical engineering professor at Northwestern University started marketing the first portable transistorized EEG. There was a small shop there, much like the Hopkins shops, headed by a technician I believe name Matt Petrovick and where I suspect the Offner EEG was developed. Offner also marketed some rack mounted transistorized biomedical multi-channel amplifiers for researchers. Beckman Instruments purchased Offner’s instrument line to add to its expanding line of research devices. The Boston area had several companies manufacturing medical instrumentation, Harvard Instruments marketed a number of devices and Olson and one other company were marketing what were known then as "heart-lung machines." Tektronix started marketing a low-level amplifier packaged like its 160 series. Tektronix was considering marketing a line of medical research instrumentation and hired Cullen Macpherson, a former graduate student under Otto Schmitt, to develop a family of stimulators and amplifiers. However, Tektronix eventually decided not to enter that market and Cullen left to found Argonaut Instruments and proceeded to market just such a line. Argonaut was quite successful up to the early 70’s when government funding for research was shifted more to the clinical areas than the basic research areas. Eventually Argonaut’s business, primarily based on medical research diminished to where the company closed.
Another of Schmitt’s graduate students, Loren Parks, was also briefly employed at Tektronix before leaving to start his own business marketing ham radio devices. He later branched into the medical device field as Parks Electronics. I first became aware of Parks Electronics with what we called his "ticker boxes" – a pediatric R wave recognizer that sounded a tick with each heartbeat, allowing nurses to audibly detect abnormalities. But later he became best known, and most successful, with his Doppler flowmeters. Again, like the Tektronix 160 series, I have encountered his Doppler units all over the world.
Another imaginative radiologist, Dr. Charles Dotter, chair of the Radiology Department, had an idea for unblocking an artery in the lower limb. We talked about what kind of wire might be threaded into the artery to break the plug and came up with a speedometer cable with an augur welded on to the tip. I always say it was a Volkswagen cable but cannot verify that. The woman’s lower limb was dark from the lack of blood flow and when Dotter threaded in the cable and rotated the augur it was dramatic to observe the color change when flow was restored. Thus began the era of catheterization, particularly cardiac catheterization. Eventually Dotter made the cover of a Radiology Journal for this work. And a few years later a General Electric cardiac catheterization laboratory was installed in the University Hospital. Possibly one of the first in the country.
When I attended on the major electronic shows known as WESCON (Western Electronic Show and Convention) in the summer of 1959, I returned with a small metal mesh sample of photographically produced micron size square holes. I showed these to Dr. Roy Swank, chair of the Neurology Department, who was interested in ways of measuring blood viscosity. He thought that forcing blood through a mesh like this might distinguish between normal blood and blood with clotted aggregates in it. On that premise we developed a machine to force a syringe of blood through such a mesh at constant speed and read the pressure developed across the mesh – to become know, and eventually marketed, as the Swank Blood Viscosity Machine.
These are just a few examples of much original equipment we developed for researchers and clinicians throughout the late fifties and the sixties. In 1965 I added a master glassblower, originally from Germany. He quickly became overwhelmed with request for specialty glass products. One biochemist, Dr. Howard Mason, was doing research in electron spin resonance and need considerable specialized glass and quartz products for his studies. Gunther Weiss was able to fulfill all his needs. Unfortunately, a few years later, Gunther left to start his own business, still existing as Weiss Laboratories. I was never able to find another glassblower of his caliber.
The Institute of Radio Engineers (IRE) formed a number of specialty groups in the early fifties. One being the Group on Medical Electronics. This group started conducting an annual meeting in the late fall which biomedical people from all over the country were invited to attend. I was fortunate that my University supported my attendance to this annual meeting where I was able to meet contemporaries from all over the country, most from medical universities and university hospitals. One as I mentioned earlier was Emil Barrish, director of the University of California Medical School’s R&D Lab and with whom I often roomed with at subsequent meetings.
In the fall of 1959, I received a visit from a local high school physics teacher, Larry Mills. Larry had been approached by Dr. Robert Dowe, a neurosurgeon at Good Samaritan Hospital in Portland. He wanted Larry to set up a support facility similar to mine at the Med School. I showed Larry around and explained the basics of what I considered an appropriate shop. He took the position at Good Samaritan but his shop mainly focused on electronics and engineering. Larry and I maintained close and cooperative contact until his untimely death in 1984. We both attended the national fall annual biomedical meetings engineering which were originally put on by the IRE’s Group on Medical Electronics later to become the Alliance for Engineering in Medicine and Biology. The Alliance came about through the efforts of Dr. Lester Goodman who had succeeded Larry Crisp as Director of the NIH’s Instrument Section and through his political prowess had advanced it to Branch status as the Biomedical Engineering Instrument and Development Branch. Also using his political prowess he had turned the fall Group on Medical Electronics annual meeting into an umbrella meeting supported by a number of other medically related societies and known as the Alliance for Engineering in Medicine and Biology. Through attendance at these meetings Larry and I got to know other engineers and technicians in organization similar to ours and how I got to know and become close friends with Emil Barrish, the then head of the R&D Lab at San Francisco’s Medical School. Each of our operations had to be self-supporting operating on a fee-for-service basis. When I started my shop, I had no basis on what hourly charge I would have to make to break even. So I started at the last rate I knew was charged at my old shop at NIH and then adjusted as experience was developed. I think Larry started using my rates and adjusted the same way. At the annual meetings Larry and Emil and I would compare notes and if one was much lower we would accuse him of having a subsidy. And in my case I rarely broke even and would have be bailed out at the end of the years, as I believe was also the case for Larry and Emil.
In the fall of 1963, I was able to move my shop into expanded quarters in the new Research Building. I was also noticing the advances in electronic technology and its impact on a growing variety of medical technologies. I found the development of the operational amplifier to be one of the most significant technology advances as it made circuit design so simple. I first encountered the Philbrick vacuum tube one and used it to construct a voltage clamp for the iontophoresis work of one of our biochemistry professors. Although it was priced at well over one hundred dollars, the trade-off in reduced design and construction time made it cost effective. Shortly after purchasing some of the Philbrick units I discovered the transistor "cord wood" (a small one-inch plastic cube) versions priced at sixty- nine dollars. When that price dropped to thirty-nine dollars I decided to lay in some stock believing that to be a bottom price only to see them drop to fifteen dollars. Shortly after that came the 301 eight pin IC version with prices dropping to the single digits. The 301 became the work horse of the industry for many years after that. When I opened up an Offner rack mount physiological amplifier I found it entirely built around 301’s.
In the fall of 1964, as I was expanding my shop staffing, I was fortunate to hire Bob Morris and appointment him my assistant director. Bob was not only a talented engineer (although he always pointed out his degree was in physics) he had a boundless curiosity. We both enjoyed investigating new technologies and whenever I could, would purchase new technology sample devices for us to play with and understand. This contributed greatly to a unique variety of devices we designed for our research clients and publications that came out of my department. Three of our papers became presentations at the International Federation Meetings in Stockholm in 1968.
Each year through the sixties I was able to take Bob and occasionally one of my technicians to the annual fall Alliance Meetings. It was at these meetings, Bob and Larry Mills, who also attended, and I were able to meet contemporaries from other medical school and hospitals; Manny Furst at Tucson, Larry Fennigkoh at Wisconsin. Mike Schafer at Washington Hospital, Joe Dyro at Stoney Brook, Bob Stiefel at Johns Hopkins, Tom Bauld at Michigan, Dave Harrington at Mass General; and so on.
By the mid sixties many of this group were aware that the Alliance Meeting mainly focused on medical and biological research rather than clinical medicine. Thus a small group of physicians, engineers and manufacturers worked to form another organization more directed at technology in clinical medicine; ie AAMI, the Association for the Advancement of Medical Instrumentation was formed and launched in 1965 and rapidly overtook the Alliance as the premier annual meeting for engineers, technicians, physicians and manufacturers.
The sixties was also a period of continuing growth in technologies: solid state technologies and materials technologies supporting dynamic advancements in life science devices. Advances in membrane technology supported the development of dialysis machines as well as blood oxygenators necessary for the cardiac bypass pumps for open heart surgeries. An early dialysis machine came from the efforts of a Portland surgeon from Good Samaritan Hospital and a local machinist that became the Drake-Willock dialysis machine. Meanwhile others were developing cardiac pacemakers, small enough to be implantable and eventually even to include automatic defibrillation. Biomaterials technology was providing implantable encasements no longer being rejected. Similar advances were expanding the analytic instruments of the clinical laboratories and speeding up larger and larger tests and results. Similarly the prosthetics industry was also benefitting from all these technology advancements to the extent that whole new technical group was being formed.
Cardiac cath labs were evolving thanks to the development of the flexible catheter pioneered by Dr. Dotter of the University of Oregon Medical school and one of the earliest was set up there by General Electric whose engineer Al Tucker transferred from GE to the Medical School to provide the technical support. As these more advanced surgical procedures grew the follow-up monitoring called for special hospital ward areas that became the intensive care areas with expanded monitoring of the patients vital signs. These monitors all had alarms to notify duty nurses of potential problems. It was long before the cacophony of alarms became a problem from the pediatric to the adult ICU’s. Although much effort has been applied to solve this problem it still exists to some extent today.
In 1965 I was able to add a master glassblower to my department, thus rounding it out to a miniature version of my NIH days. And the staffing total had grown to twenty technicians and engineers. Our business, mainly from the researchers, little from the hospital, was booming.
But unfortunately, in the late sixties funding for basic research started to drop as the government decided it was time to turn funding towards clinical medicine. I remember one wag saying the government has decided now that you have created all these neat gadgets in your basic research it is time to get them into the clinical arena. And then in 1970 came the big electrical safety scare when Ralph Nader in a Ladies Home Journal article contended as many as 1200 patients are electrocuted every year.
This generated a push to develop mandated leakage standards for medical equipment. Based on one report of a dog’s heart being fibrillated by as little as 14 microamps the 10 microamp standard became the requirement for all medical devices with subcutaneous attachments. A standard very difficult to meet for devices still employing vacuum technology. For other attachment devices the standard was 100 microamps and 500 microamps for other devices in general. Attention as also being given to wiring devices which resulted in hospital grade plugs and receptacles and testing devices to assure contact tensions. Hospitals were found to have notoriously bad wiring devices. Receptacles with broken faceplates. Rampant use of extension cords of dime store quality. I had my technicians start inspecting the wiring devices in our hospital. We removed or replaced the worst as we could but if we red-tagged everything we would have shut down the hospital.
At this time there was a push to recognize the engineering specialty of clinical engineering. And to do so by a certification process. Two groups were vying for the right to certify. One I believe was the ABCE? supported by academia. The other the CCE I believe supported by AAMI. That one won out and grandfathered the first 49 in 1974. Interestingly three were from Portland, Oregon, Bob Morris, Larry Mills and myself. I know of no other city that can make that claim.
In the early seventies the workload for my department from the research people that had been so prolific diminished to where I was compelled to lay people off. My staffing fell from a high of twenty people to eight. My glassblower and several technicians all left for United Medical Laboratories, at that time the world’s largest clinical testing laboratory. More and more of my work came from the hospital and eventually we developed an inventory of hospital equipment and started a safety testing program.
One summer night Bob Morris, Dean Bailey, another of my engineers, and I were having a beer in my back yard. One of them asked, "How came our University has no computer center." I replied, "I guess because no one knows how to run one." Their response, "We do." With that I went to my boos, the business manager and sold him on the idea to where he allocated $10,000 for us to start. With that we acquired and IBM 1130, card punch and card reader and opened shop. As Bob and Dean ran that it kept my department alive for a little longer. But the computer operation succeeded to where it finally split off and moved upstairs to another research computer location for expanded activity which Dean ran and Bob left to join the department of Clinical Pathology.
At the annual Alliance and later AAMI meetings I became acquainted with a growing number of biomedical engineers and technicians and many now referring to themselves and "clinical" engineers. As a sort of core group we began to share experiences and management strategies to improve our hospital operations. And in 1975 Al Pacella, formerly an engineer at Beckman Instruments, started a publication devoted to our profession, the Journal of Clinical Engineering.
In 1983 the University Hospital decided that since 90+ per cent of my business came from them I should become part of the hospital. After twenty five years of a third floor location in the Research Building with a view of the city and the mountains my department became resident in the hospital basement like all the other biomed and clinical engineering shops in the country.
In 1985 Manny Furst pulled together a small group, less than twenty I believe, for the first Biomedical Engineering Conference on Cost-Effective and Productivity at the Massachusetts General Hospital in Boston in May of 1985.