Complexity, Trouble & Triumph

"We can't keep a pacemaker going more than two years," complained one cardiologist. "Manufacturers don't service electrocardiograph machines," wailed a hospital administrator. Last week medical men with such plaints got together in Boston with physicists, engineers and manufacturers in a 4,000-strong symposium of the Association for the Advancement of Medical Instrumentation. Purpose: to find cures for sick tools, from ailing pacemakers to leaking artificial kidneys.

Since the days when the stethoscope and blood-pressure cuff were the only instruments that most doctors used, medical technology has acquired a huge array of machines -- cryoprobes, air-driven bone saws, laser-beam knives, nuclear reactors to irradiate brain tumors. No less troublesome than the complexity of the devices is the lack of standardization: diathermy machines made by two manufacturers for the same purpose have dials calibrated on different scales, so doctors must translate one to the other for comparisons. And there is no assurance that either scale or machine is accurate.

Out of the Shack. Partly, this is the fault of medical men, especially surgeons. "We spent a small fortune designing a special brain probe," said Tullio Ronzoni of Aerojet-General Corp. "In two years we have sold exactly one -- to the doctor who first asked for it. Every other brain surgeon wants his own design." Manufacturers share the blame. "Many of what were passed off as cardiac monitors were just old oscillators out of the radio shack," admitted Ronzoni. By week's end medicos and manufacturers alike had loudly agreed to work harder to get the bugs out of the gadgets. With all their frustrations, the medical technologists and researchers reported some triumphs:

>The new Doptone, based on the Doppler effect, transmits a narrow beam of very-high-frequency sound into the abdomen, detects fetal life and heartbeat after the tenth week of gestation, with out harming the mother. It also pin points blockages in peripheral arteries, as a guide to surgery.

> After long testing of remote-control electrocardiography under routine conditions, including transmission of the signals by telephone line and computer evaluation, the U.S. Public Health Service is ready to extend its hookup from Washington to the emergency room of Connecticut's Hartford Hospital. After receiving the ECG signals, the computer will shoot a diagnosis back to Hartford within 15 seconds, whereas it might take hours to find an expert cardiologist to give a reading.

>Cardiologists taking ECGs of youngsters in Kansas City, Kans., schools during energetic exercise were baffled by electrodes' washing off in the kids' sweat. The remedy: a spray-on, stay-on conductive electrode cement, developed by NASA for test pilots.

> Psychologists at Pensacola Naval Air Station now give pilot-training candidates an aptitude test by punch keys and computer in 45 minutes, as against two days with pad and pencil.

The Chick's Heartbeat. NASA Consultant Quentin L. Hartwig reported a fascinating example of the application of space research to earth-bound medicine. To record the impact of a speck of interplanetary dust on a man or vehicle in space, Engineer Vernon Rogallo devised an instrument so sensitive that it registered the force of a single grain of salt dropped less than one-half of an inch. Then, at the NASA Ames research center in California, Rogallo overheard a cafeteria conversation between two biologists: How could they record the heartbeat of a six-day-old chick embryo without piercing the egg shell?

Rogallo made minor modifications in his dust detector, the biologists supplied the egg, and the unborn chick's heartbeat registered strongly through its unbroken shell. As proof, Rogallo exhibited the live and healthy chick of a bobwhite quail whose incubation had been monitored but undisturbed. And, said Dr. Hartwig proudly, the Food and Drug Administration is completing the space-to-chick-to-man cycle: it is using Rogallo's sensor to study the effects of drugs on the heart.

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