AW Melville, a pioneer in New Zealand medical electronics and inventor of the Fisher & Paykel Humidifier.
|Publication:||Name: Anaesthesia and Intensive Care Publisher: Australian Society of Anaesthetists Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 Australian Society of Anaesthetists ISSN: 0310-057X|
|Issue:||Date: July, 2009 Source Volume: 37 Source Issue: 4|
|Topic:||Event Code: 200 Management dynamics Computer Subject: Company business management|
|Product:||Product Code: 3634700 Air Purifiers, Humidifiers Etc NAICS Code: 335211 Electric Housewares and Household Fan Manufacturing SIC Code: 3585 Refrigeration and heating equipment; 3634 Electric housewares and fans|
|Persons:||Named Person: Melville, Alfred Winston|
|Geographic:||Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand|
"In this country the application of modern techniques of
physical measurement to medical instrumentation lags behind the progress
of the medical specialist."
Melville AW, 1951 (1).
Alfred Winston Melville was an electronics engineer who made a significant contribution to the development of medical instrumentation in Auckland, New Zealand, in the period from 1950 to the 1970s. The purpose of this communication is to outline and to acknowledge his achievements. He would perhaps be best remembered by intensivists for his invention of the "Auckland Humidifier", which became the widely employed Fisher & Paykel Humidifier (2).
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Alf Melville produced an in-house memoir (3) of his career and activities, from which the following two paragraphs are drawn (a career outline appeared in the Hamlyn book Notable New Zealanders (4) (p. 316), while Keith Davies (5) has also briefly sketched Alf's background). He was born on a 65 acre dairy farm at Buckland, south of Auckland, attended the Buckland primary school and the Pukekohe Technical High School where he matriculated and was Dux in 1931. The economic severity of Depression times precluded his undertaking higher education; work was scarce and so he worked on the family farm. But Alf did not take to farming, moving in 1933 to plumbing construction and in 1935 to working for the New Zealand Railways, installing telephone equipment. On being called up for service in World War II, he started with the Tank Corps but in December 1941, obviously earmarked as a result of the particular technical expertise he had attained, he was directed to a radar development laboratory in Wellington for intensive training. (Radar was new at that time.) After installing some coastal watching stations around the North Island, he transferred to Auckland in 1943 to take charge of a secret radar development laboratory producing and installing naval radar equipment, then for the air force with extensive airborne testing.
AUCKLAND INDUSTRIAL DEVELOPMENT DIVISION
At the end of the war, Alf was invited to join John Brooke (4) (p. 64) (Figure 2) in establishing the Auckland Industrial Development Division (AIDD), a new Division of New Zealand's Department of Scientific and Industrial Research, which operated from 1926 to 1992, set up to assist the development of industry in the Auckland area (3). Alf was appointed head of the Electronics Section and studied part-time to obtain professional qualifications. In 1949 he started a program of medical instrumentation which involved staff from the physics, mechanical design and instrument workshop sections, the group making significant contributions to several medical specialties in Auckland from the 1950s to the 1970s. As this activity progressed, Alf helped the hospitals to recruit staff who could take over operation of the equipment being developed and begin some in-house development themselves. The first technical officer he recruited, Sidney Yarrow at Green Lane Hospital, recalls how outstanding an innovator and teacher Alf Melville was (personal communication, February 2009).
ACTIVITIES FOR GREEN LANE HOSPITAL, AUCKLAND
Alf's interest in medical instrumentation first arose in 1949 when he received an urgent request through the Department of Scientific and Industrial Research from Dr GFV ("Eric") Anson, Director of Anaesthesia in Auckland, to devise a pair of remote-controlled grasping forceps which would enable extraction of a screw, lost in the respiratory tree of a child at Green Lane Hospital (6) (p. 42), (5). This Alf achieved "speedily and successfully" (6). It was on the succeeding day at that hospital that he first watched some "embryonic" cardiac surgery (5) and immediately recognised the possibility of helping the medics with several technical problems. He later wrote that "it is largely due to his [Anson's] continuing interest and assistance that the work has proceeded" (1).
His Medical Instrumentation and Research and Development Group initially became very actively involved with the Cardio-Surgical Clinic1,7, the group's achievements with the Clinic firmly establishing his reputation. Other medical groups learned of the work, resulting in their activities being expanded to include the development of instrumentation for obstetrics, oncology, surgery, radiology, medicine and critical care. Alf was the initiator and organiser of the projects. In the early stages he was the designer/developer of electronics, although this role was taken over by Bevin Cornwall (Figure 2) in later years as Alf became more involved in management, eventually becoming the Director of AIDD. Thus most of this amiable and inventive man's career was given, with great energy and drive, to full-time public service in the field of medical electronics.
Alf Melville's expertise was often called on in the early days for, as he noted, at that time "Physiological measurements were primitive and apart from the electrocardiogram, practically no electronic instrumentation was available" (3). The volume of work undertaken is evident in his bibliography of papers, which demonstrate innovation, design and productivity. In his memoir3 he recorded initial technical achievements in intracardiac and intravascular pressure recording at Green Lane Hospital (1,7) (starting in response to requests from Dr James Lowe, senior cardiologist recently returned from the National Heart Hospital, London, where water manometry was still being used in cardiac investigation--which "horrified" Alf (6) (p. 42) since they had not yet advanced to electronic recording):
"... we had replaced the crude water manometer originally used at Green Lane for recording pressure during cardiac catheterisation with a newly developed recording instrument which gave an immediate recording of both systolic and diastolic pressures. This was followed by the development of a special spectrophotometer for instant estimation of oxygen saturation of blood. For theatre use I developed a method of measuring pressure in large vessels during open chest surgery requiring only very fine hollow needles which could pierce the wall of a large vessel, record the pressure instantly and be withdrawn without causing leakage of blood. I also produced a cardiotachometer which indicated the heart rate in the form of a continuous paper record which was of special value to the anaesthetist when new [especially cardio-thoracic] surgical procedures were being used" (3). (It was used for patients under operation and when exercising (6) (p. 42-43), (7).)
By 1951 Alf had documented his "shock defibrillation" system1 and for Dr James Lowe he recorded (and converted to an electrical potential) movements throughout the cardiac cycle of the anterior surface of the left ventricle, and of the septum, with electrocardiogram lead-2 correlation (6) (p. 60). A 1959 Melville-Cornwall paper (8) described the use of their ratemeter in cardiac applications, for measuring the interval between each heartbeat but providing an output calibrated in beats per minute. This was later improved for use in obstetrics (9), as described below.
Mention of his cardiac/cardio-surgical inventions also lies within the 1889 to 1982 history of Green Lane Hospital, recorded by Drs Edward H Roche, physician, and his son Antony HG Roche, cardiologist (6), as well as in the original Melville papers, many not so readily accessible now. But Bevin Cornwall, whom Alf recruited to AIDD as a trainee in 1950 (eventually becoming its fourth director), emphasised to me (10) that in the early 1950s several other hospital departments, such as those for renal dialysis, cancer treatment, neurosurgery, plastic surgery and later, orthopaedics, were all benefiting from the expertise of Alf's enthusiastic group.
Thus, the Melville injection device for angiocardiography (11) standardised the procedure, providing better pictures and more information. At the time he also worked on a phrenic nerve stimulator for controlling diaphragmatic breathing (3). Other projects at this time involved ear1 and whole blood (3) oximetry, temperature-measuring equipment for use in operations under hypothermia (1957) (3) and equipment recording dye dilution curves for circulatory studies (10). When a Melrose heart-lung bypass oxygenator arrived in New Zealand in 1957, the group were able to provide technical support for the considerable amount of modification it needed (12), to the redesign specifications of clinical perfusionist Sid Yarrow (6) (p. 65), (12).
[FIGURE 2 OMITTED]
ACTIVITIES FOR NATIONAL WOMEN'S HOSPITAL, AUCKLAND
Alf Melville and the AIDD team developed fetal monitoring (9), drip rate recording equipment (to provide which, they were "hard-pushed" (10)) and an elegant neonate-sized tank-respirator for intermittent negative pressure ventilation (13,14) (Figure 3). The last was in answer to a request from Professor Harvey Carey of National Women's Hospital, Auckland in 1956 and Alf could claim the respirator "incorporated a number of ingenious mechanical and electronic innovations" (14). (Bing Hodder was the mechanical engineer responsible for the mechanical design of the unit10.) After the respirator provided 28 hours of employment in its initial use (14), it was recorded as "in regular use" in 1958 and that "dramatic results have been obtained in some cases" (13). It appears however, that no case histories were documented in the medical literature, although two successful uses for newborn ventilatory failure by eminent researcher and innovator Dr A William (Bill) Liley, 1929 to 1983, (later Professor Sir William) are known of to pioneering neonatal intensivist Dr Ross Howie (personal communication, April 2009). But when Dr Howie arrived at National Women's Hospital in January 1962, it appeared the respirator had not been used "for some time", after Dr Liley had some failures and had given it up, so "Bill passed it over to me to see if I could do any better. I couldn't ... There were serious problems of the machine in practice ... That was a huge pity, as the machine was beautifully designed and engineered: you could say it was magnificently impractical" (Dr Ross Howie, personal communication, April 2009). Bill Liley was another at National Women's Hospital who was influential in having Alf and the AIDD team provide some of the later projects (10).
[FIGURE 3 OMITTED]
To deal with "the rather 'noisy' environment when recording fetal heart signals from an abdominal microphone", a ratemeter was developed that incorporated protection against random triggering, based on "an original bright idea that Alf had" (10). This refinement is described in Alf Melville and Bevin Cornwall's 1962 paper (9). Equipment for fetal monitoring, and that for drip rate recording, was "used quite regularly" (10).
For the Supervoltage Therapy Unit, in 1961 Alf designed an automatic "Isodose Recorder" (11) (now superseded by an isotype radiation source, etc.) to first record the dosage of high voltage radiation absorbed by a "water phantom", a kind of simulator enabling more precise and safer treatment (3).
Bevin Cornwall explains (10) the essential point: "Of course you can buy this equipment quite easily now, but you couldn't then", it was all pioneering work. Alf's last paper about medical electronics would appear to be from 1976, with JB Cornwall (15) describing equipment for radio telemetry, respiratory humidification, heartbeat totalising and auto injection. Here the authors indicated that at AIDD, "Generally effort has been aimed at producing equipment and techniques that are not available commercially". Pioneers indeed! (See Footnote.)
THE "AUCKLAND HUMDIFIER"
Alf's multiple prototypes were developed into the "Auckland Humidifier", as it was known originally, then passed on to and further developed by Fisher & Paykel. The story has been told in this journal (16) and elsewhere (2,5,17). Fisher & Paykel's progressive refinements and highly successful worldwide promotion leaves it, still, as Alf Melville's principal memorial.
I am deeply indebted to Bevin Cornwall for his generosity and kindness in so readily supplying me with much information and many papers, little of which I would have been able to obtain otherwise. Also to Dr Ross Howie and Sidney Yarrow for their valuable advice. The Philson Library, University of Auckland has been diligent in meeting all demands made on it, while I am grateful to David Churchouse of MedPhoto at Auckland City Hospital for expert assistance with the illustrations.
Accepted for publication on May 1, 2009.
The authors made their point that "Usually, the market potential for this equipment is not large in New Zealand, and there is often an understandable reluctance on the part of manufacturers to gear up for short runs or take the risk of longer, but more economical, runs. Although a number of items have been made in small quantities (less than 10), only recently have two larger manufacturing concerns been prepared to set up production of some of the items developed, on a scale that might be rewarding either by reducing the need to spend overseas funds or by earning overseas funds by exporting to other countries"15. The realities of hard economic times!
(1.) Melville AW. Instrumentation in cardio-surgery. In: Report of the Seventh Science Congress, Christchurch, May 15-21, 1951. Christchurch: Roy Soc of NZ 1952. p. 10-18. (Smithsonian catalogue, call no. Q101.N56 1951.)
(2.) Spence M, Melville A. A new humidifier. Anesthesiology 1972; 36:89-93.
(3.) Melville AW. Memoir (undated). Copy available from author (RVT).
(4.) Knox R, Jackson D, eds. Notable New Zealanders: The Pictorial Who's Who. Paul Hamlyn Ltd, Auckland 1979; p. 527.
(5.) Davies K. Defying Gravity. The Fisher & Paykel Story. 70 years of innovation. Auckland: David Ling, 2004; p. 311.
(6.) Roche EH, Roche AH. Green Lane Saga a record of Green Lane Hospital, Auckland in the development of cardiology and cardiothoracic and vascular surgery. Auckland: Ray Richards, Green Lane Hospital Staff, 1983; p. 229.
(7.) Melville AW. Pressure measurements in the human organism. NZ Med J 1953; 52:493-496.
(8.) Melville AW, Cornwall JB. Rapid response recording cardiotachometer. Electronic Engineering 1959; May:268-271.
(9.) Cornwall JB, Melville AW. A rapid response ratemeter with protection against random triggering. Electronic Engineering 1962; 34:537-539.
(10.) Cornwall JB, personal communication (February to March 2009).
(11.) Beasley WR, Melville AW. Automatic isodose recorder. Br J Radiol 1961; 34:648-654.
(12.) Yarrow S. How it all started: New Zealand's first open heart operation. NZ Med J 1989; 102:353-355.
(13.) Melville AW, Hodder BH. A servo-operated respirator for premature infants. IRE Trans Med Electron 1958; PGME:75-81.
(14.) Melville AW. Servo operated respirator for premature infants. "AIDD Medical Electronics activities": Internal report ME-4, 1956. Copy available from author (RVT).
(15.) Melville AW, Cornwall JB. Medical instrumentation. Productivity and Technology 1976; p. 18-19.
(16.) Holland R. Against the odds. Anaesth Intensive Care 2008; 36 (Suppl 1):3-6.
(17.) Trubuhovich RV, Judson JA. Intensive Care in New Zealand: A History of the New Zealand Region of ANZICS. Auckland 2001; p. 120.
R. V. TRUBUHOVICH *
Auckland, New Zealand
* M.B., Ch.B., M.Sc.(Oxon), F.R.C.A., F.A.N.Z.C.A., F.J.F.I.C.M., Honorary Intensivist Specialist.
TABLE 1 Outline of career of Alfred W Melville (1916 to 2006), C.Eng. M.I.E.E. 1935-1940 Staff member, New Zealand Railways Communications Branch 1940-1945 Officer-in-Charge, Radio Development 1945-1955 Laboratory, Department of Scientific and Industrial Affairs 1955-1961 Senior Electrical Engineer, Auckland Industrial Development Division (Laboratory), DSIR 1961-1964 Assistant Director, AIDD, DSIR 1964-1971 Senior Liaison Officer, New Zealand High Commission, London 1971-1976 Assistant Director, AIDD, DSIR Director, AIDD, DSIR. AIDD=Auckland Industrial Development Division, DSIR=Department of Scientific and Industrial Research.
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