Amazing Devices

“Curmudge, nothing documents your antiquity more convincingly than when you talk about the devices you used early in your career.”

“I recall that before the days of photocopiers I had to make 12 copies of an exam by dragging each page plus a so-called ‘master’ through some sort of magic bath. Then the copies were spread out on the counter to dry. I was grateful there weren’t more than a dozen people in the class.”

“That must have been when you had a moonlight job teaching chemistry in the early 1960’s. Since then, advances in all sorts of devices and instruments have really been dramatic. In health care even the simplest of measurement tools, like the glass rectal thermometer, have been replaced. There can’t have been many things that have remained the same. Can you think of one?”

“I sure can, Jaded Julie. What about the stethoscope? It’s not even a scope; it’s a hearing device and should be called a stethophone. It’s still used to listen to the heart and lungs and for measurements of blood pressure. There are anecdotal reports that replacing the stethoscope and manometer with electronic sphygmomanometers yields higher bp’s. However, studies reported in the literature suggest that the methods give comparable results (1, 2). When my wife was in a Czech hospital a year ago, the electronic sphygmomanometer in her room appeared to be the only modern device in the facility.”

“What about pulse oximeters, Curmudge, for measuring the oxygen saturation of blood? The devices clipped onto the end of one’s finger have been in use for a long time, but on your time scale you’d probably consider them a modern invention.”

“You’ve got that right, Julie. When I was studying the use of near-infrared spectroscopy for analysis of wood pulp in the late 1980’s, I met a woman in a short course who was studying near-infrared for clinical applications. Among her interests was pulse oximetry. It seems like only yesterday. Prior to that time, the test of O2 saturation was invasive and labor intensive.”

“I understand that you had in your lab a predecessor of today’s magnetic resonance imaging (MRI) device. That must have been at least 30 years ago.”

“It was a nuclear magnetic resonance (NMR) spectrometer. A solution of the sample was put in a small tube and spun at high speed for the measurement. Someone put a lot of work into scaling up the system to the point where the ‘sample’ is a human lying quietly (not spinning) in the magnetic field. I think they changed the name from NMR to MRI because the term ‘nuclear’ alarmed patients.”

“Speaking of laboratories, Curmudge, clinical labs have undergone great changes over time, haven’t they?”

“I never worked in clinical chemistry, Julie, but I was in a research group with people who did. Leonard Skeggs’ development of the AutoAnalyzer revolutionized clinical chemistry (he was in Cleveland; we were in Madison). He found that samples could be separated from one another by air bubbles as they were pumped sequentially through plastic tubing into as many as 12 concurrent analysis modules. By now, modern lab instruments have undoubtedly displaced the old AutoAnalyzers.”

“While Skeggs and others were automating the clinical laboratory back in the 1960’s, what were you doing?”

“As a research associate in biochemistry, I was developing an instrument for the continuous determination of cyanide in grass. And I’ll answer your question before you ask it; it was not the kind of grass that lots of people were smoking back then. Despite the student riots, Madison was a pretty stimulating place in the late 60’s.”

“Curmudge, other than ‘Gee Whiz,’ what’s the lesson from today’s discussion?”

“Lessons plural, Julie. Most importantly, one should embrace change, both technological and organizational as in Lean. Both kinds of change will make our lives more productive and enjoyable. The second lesson is that one should take a moment to look around and appreciate the astounding developments that have occurred in science and health care in a few short years. Everyone should be inspired to shout an emphatic ‘Wow!’ We’ll talk more about this in later postings.”

Affinity’s Kaizen Curmudgeon

(1) McManus, R.J. et al. Does changing from mercury to electronic blood pressure measurement influence recorded blood pressure?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314749/pdf/14960220.pdf
(2) Elliott, W. J. et al. A comparison of two sphygmomanometers that may replace the traditional mercury column…
http://www.ncbi.nlm.nih.gov/pubmed/17303984