The Machines of Progress

The man on the opposite page is not made up for a Hollywood horror movie.

He is undergoing a sensitive and still experimental examination designed to detect changes in blood flow and temperature that may be produced by vas cular disorders. Capable of indicating temperature variations as small as .047DEG F, the liquid crystals he has been painted with were originally developed for testing mechanical stresses in deli cate instruments. But their quickly identifiable color changes may prove far more valuable for humans.

Such new diagnostic techniques are typical of a whole sunburst of medical marvels that cover a spectrum as wide as the liquid crystals' own color range. In addition to teaching doctors to see with colors, engineers have also shown them how to see with sound. Ultrasonic beams bounced through a patient can spell out a fuzzy picture of all they encounter. Operations can now be carried out in an environment that is virtually germfree. The new device may be as comparatively simple as a heart cart that contains everything from a cardiac pacemaker to a supply of oxygen, and can, in effect, rush the entire equipment of a hospital emergency room directly to a heart patient's bedside. Or it may be as vastly complex as the proton gun currently being used by Harvard Neurosurgeons Raymond Kjellberg and William Sweet.

Sound & Fury. Using 700-ton magnets, Harvard's cyclotron fires a proton beam with the force of 160 million electron volts. But after leaving the cyclotron, the protons travel a precise and predictable distance before they release their power. Careful positioning of the patient allows the beam to pierce the skin with little damage before releasing all its energy and destroying a specific target deep inside the body--such as the pituitary gland, perhaps, or a brain tumor.

In one way or another, much of the new medical machinery is beneficial fallout from the miniaturization and precise measurement techniques learned by space-age scientists. Like protons, the furious but controllable forces of laser beams have already been used as exact surgical scalpels; at the National Institutes of Health, laser light is also being showered on cultures grown for only four hours in tiny, 2-mm. capillary tubes. The resulting scattered light can be read for presence of bacteria. Because the process is so highly accurate, the cultures do not have to be nourished for days until they grow large enough for the disease-causing microbes to be detectable. The careful placing and size of an electrical charge is the key to Peri-Start, a machine built on the principle of the cardiac pacemaker. It electronically stimulates the muscles of bladder and colon and controls elimination in a paralyzed patient. In the future, the same technique may well prove practical for other muscles.

The catalogue of medical engineering advances grows almost daily. Last week in San Francisco, at the annual meeting of the American Roentgen Ray Society, a novel, three-dimensional fluoroscopy machine was displayed by General Electric. A complex welter of mirrors, polarizing filters, lenses, an image intensifier and a two-cathode X-ray tube (see diagram), G.E.'s Stereo Fluoricon shows a patient to his physician as a green 3-D image, "like a skeleton with its organs hung inside." Other X-ray machines and sonar beams have produced similar 3-D effects, but previous processes were too cumbersome or time-consuming to be easily utilized. G.E.'s machine can do the job in a few minutes, thereby cutting the time the patient is exposed to X rays.

New Breed. Mechanization has increased medical instrumentation sales to an estimated $300 million this year, compared with two-thirds that amount in 1964. But the fantastic growth has not been without its problems. "A lot of these machines are relatively useless," complains Dr. John Knowles, director of Massachusetts General Hospital. "And they are pushing up costs astronomically, because people are beginning to feel they have to step into a machine to get the best treatment." Taking the opposite view, Robert Allen, editor of the Journal of the Association for the Advancement of Medical Instrumentation, argues that "doctors simply don't understand the new machinery. Often they feel threatened. A machine between them and their patients tends to make them lose confidence in themselves."

Such comments reflect the distance that still separates the doctor and the engineer. "What is needed," says Dr Joseph B. Boatman, chief of physiology and biophysics at Battelle Memorial Institute, "is better communication. The physician must learn to ask the right questions of the right people. Medical research must bring together many skills and many backgrounds. What we lack is a school to train medical research clinicians. The whole purpose of medical schools is to train physicians to treat patients and there is no room to train researchers. Medical school should stop making research a secondary interest."

Boatman's advice is slowly being followed. In 1960, few, if any, medical schools offered more than a smattering of instruction in medical technology. Now a dozen institutions are reaching for help from nearby technical schools. And they are training a whole new breed of surgeons. Working along with engineers and scientists, says Dr. Boatman, these men will develop new techniques--for heart trouble, strokes, cancer--the list is endless.

"We will develop very sophisticated capabilities of repair," promises Boatman. Mechanical hearts, pacemakers powered by the body's own energy systems, implanted television eyes for the blind, even hospitals in gravityless, germless space--all such things seem possible now that medical men are beginning to take full advantage of the expanding skills of modern technology.

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