By Bill Peckham
Two new interviews are available through the Nephrology Oral History Project, Richard J. Hamburger, MD and Louis H. Diamond, MBChB. These continue to expand the record of the early years of dialysis. I've listened to a couple snippets of the new material. I enjoy listening to the doctors tell their stories but this December, 2000 interview of Albert "Les" Babb conducted by Frederik Nebeker for the IEEE History Center, is excellent reading. Babb gives a clear first person account of the early days of chronic dialysis in Seattle.
Babb's involvement was to develop a way to mix dialysate on a large scale simplifying the dialysis process and making it less expensive (Babb's central dialysate delivery system for multi-patient dialysis cut the per year, per patient cost of dialysis from $20,000 to $10,000). Starting here in the interview Babb explains how a bunch of engineers who were working on the University of Washington's nuclear reactor ended up making home hemodialysis a reality. It's a pretty amazing story.
As Babb explains his involvement he gives a thorough overview of hemodialysis circa 1962 and the state of the process that he came to understand in those early days. Babb brings an engineer's understanding to dialysis. First Babb created a system to serve an entire dialysis unit - 5 stations at the time; then Scribner gave him a tougher challenge. He needed Babb to take what he had created for a unit, and shrink it down so that someone could use it in their home. And he needed the device in 4 months.
Babb and his team of engineers met the four month deadline. This photo from the HDC Dialysis Museum is of an early dialysate proportioning system developed from the prototype "Mini-1" machine designed by Babb. It was this device that made home hemodialysis a reality. In one of the twists of fate that weave through the early days of dialysis, Babb and his team were working for the benefit of someone he knew well. Babb's original Mini-1 prototype was used on an experimental basis to provide dialysis in the home of his good friend for a daughter. A daughter that had been turned down by the Seattle selection committee.
Later in the interview it's mentioned that a paper Babb wrote received landmark status, Google suggests that it was Hemodialysis International that bestowed the honor. He and Scribner were trying to figure out "how many hours a week a patient should be dialyzed." I was struck by one passage:
A lot of the work we did after that [creating the dialysate proportioning systems] was mathematical and we tried to model this process to see if it could be optimized. We suggested three 8-hour treatments per week rather than two 12-hour treatments were more optimal and convinced the medical staff to switch to this practice. By the beginning of 1964 I was feeling somewhat relieved that this was done.
The phrasing "somewhat relieved" suggests that he thought that three days a week wasn't quite right. I wonder if it ever crossed his mind to suggest every other day dialysis? It was a unique time here in Seattle. A time when Scribner could pick up the phone and get a team of nuclear engineers on a dialysate job and a nuclear engineer could call Scribner and make hemodialysis dose recommendations.
Reading this and listening to the Oral History Project interviews you get a sense of the pragmatic, problem solving group of men (definite gender bias evident) that launched ongoing dialysis. They pushed forward, solved problems, made it work. Back when you could just make it work. Today the red tape has caught up with interest.
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