Machines in Our Hearts: The Cardiac Pacemaker, the Implantable Defibrillator, and American Health Care
Hamilton Cravens, Kirk Jeffrey · Journal of American History · 2002
American health care has become expensive. Much of this has to do with medical technology, those devices that often perform miracles—and are often more costly than one would like to imagine. No one gets out of this life alive; nevertheless, modern medicine can do much to manage the chronic diseases that afflict us in middle age and beyond. Here is a model monograph on an aspect of this post- World War II phenomenon, the development of a technology that can artificially pace or maintain the heartbeat at a safe and healthy rate. The story is an exceedingly complex one, and Professor Kirk Jeffrey follows its twists and turns with utter clarity, technical sophistication, and high intelligence. There are astonishments in the story. A small example is that in 1976 Elmer A. Braun of Charleston, West Virginia, was diagnosed at the Cleveland Clinic as a candidate for a pacemaker someday, because of his incipient cardiac problems; the first one, implanted five years later, consisted of a pulse generator and a lead to his right ventricle. Powered by a solid-state lithium battery, it was set to make Braun's heart beat at seventy-two times per minute should his pulse fall below that rate. This pacemaker was the size of a Zippo lighter and weighed 95 grams. As predicted, the battery wore out about eight years later; this time the replacement procedure was much easier, and the new pacemaker was much lighter (at 26 grams) and was much thinner and smaller than the first. It was a far more sophisticated unit, and it could manage Braun's heart far more precisely than any instrument before it.