Background on Samuel Ruben:

Samuel Ruben was a scientist and inventor that made substantial contributions to the field of electrochemistry and electrochemical engineering (Fowler, 1988). Though Ruben never graduated from college, he received honorary degrees from several universities (Bullock, 2006). Notably, Samuel Ruben was named an Honorary Professor and Fellow of the Polytechnic Institute of Brooklyn (Bullock, 2006). Ruben held over 300 patents that went on to influence the development of military technology, satellites, electronic watches, and even the cardiac pacemaker (Fowler, 1988).

Image 1: Photograph of Samuel Ruben (The Electrochemical Society, 2014)

How the Cardiac Pacemaker was Developed from Ruben’s Battery Technology:

Though Samuel Ruben’s work was primarily focused on battery technology, one of his patents was especially vital to the development of the cardiac pacemaker. In fact, it has been noted that the first pacemakers that were powered by primary cells, which were developed around 1958, originated from Ruben’s Zinc Alkaline Electrolyte-Mercuric Oxide Cell (Salkind & Ruben, 1986).

Image 2: Images from Samuel Ruben’s Patent for Alkaline Dry Cells; Patent 2422045 (Source: Poly Archives; Samuel Ruben Papers)

The Zinc Alkaline Electrolyte-Mercuric Oxide Cell was commonly referred to as the “RM” cell, which was an abbreviation for Ruben-Mallory. It was named after Ruben, the inventor, and Mallory which was short for the manufacturer of the battery P. R. Mallory and Co.. The manufacturer later became Duracell (Salkind & Ruben, 1986)

Image 3: Mallory RM-1 Mercury Pacemaker Cell Source: Figure 1 from  (Salkind & Ruben, 1986)

The Necessity and Development of Cardiac Pacemakers in the 1950s:

In Machines in Our Hearts: The Cardiac Pacemaker, the Implantable Defibrillator, and American Health Care, Kirk Jefferey recounts the events leading up to the development of implantable pacemakers. As Jeffrey explains, around the late 1950s, heart specialists started to realize that late middle aged adults were starting to develop heart problems, such as chronically slow heartbeats and heart block. During the time period of 1957-1960, over 7 research groups started to design pacemakers to address this issue, and inventing a pacemaker that could extend lives for months to years became a goal. Furthermore, pacemakers served as an initiator of reimagining the field of electromedical technology. Jefferey notes that there were technical challenges to overcome, as clinicians were uncertain about the logistics behind implanting a machine into a human body. Nevertheless, the invention of small batteries and silicon transistors from the 1940s paved the way to the creation of fully implantable pacemakers.

As Jeffrey highlights, one notable research group was fellow surgeon William Chardack and electrical engineer Wilson Greatbatch. Upon the two meeting in 1958, Greatbatch inquired about the possibility of taking on a project to create an implantable cardiac pacemaker using Ruben mercury cells, as he was involved in the engineering space and had much knowledge on transistorized circuits (Jeffrey, 2003). Chardack, who was involved in cardiovascular research, eventually agreed to partner on this venture (Jeffrey, 2003). In 1958, Greatbatch assembled the pacemaker breadboard using Samuel Ruben’s mercury cells, which were of interest due to its high energy density and compact design (Jeffrey, 2003). By April 25, 1958, model 5 of the pacemaker had succeeded at pacing for 24 hours, and at this point, the team decided to implant the device into a dog (Jeffrey, 2003). After a few adjustments, model 7 paced in the dog for 24 hours (Jeffrey, 2003). Experiments continued from 1958-1959, especially refining the design to properly encapsulate the materials, to reach the goal of implanting this device into a human (Jeffrey, 2003). In 1959, a stage one trial was performed in a 65-year-old patient where just a Hunter-Roth electrode was implanted prior to receiving an implantable generator which was put in place for 5 weeks (Jeffrey, 2003). Two days before receiving the generator, the patient passed away (Jeffrey, 2003). The death was not connected to the pacemaker, as it was not fully implanted (Jeffrey, 2003). In April 1960, the group met Frank Henefelt, who was a 77 year-old that suffered from frequent Stokes-Adams attacks (Jeffrey, 2003). The procedure to implant the pacemaker was done in stages beginning on April 18th (Jeffrey, 2003). The second stage that involves the implantation of the pulse generator took place on June 6th and was successful (Jeffrey, 2003).

Image 4: Images of Frank Henefelt and the Chardack-Greatbatch Pacemaker (1960)

A) Pictured is 77 year-old Frank Henefelt, who became the first U.S patient to have a cardiac pacemaker fully implanted into their body. B) Image of implanted generator constructed by Wilson Greatbatch containing 10 mercury cells C) A circuit diagram of the cardiac pacemaker that was implanted; Source: Machines in Our Hearts: The Cardiac Pacemaker, the Implantable Defibrillator, and American Health Care (Jeffrey, 2003)

Henefelt was able to live for 30 months following the implantation of the pacemaker device (Jeffrey, 2003). Greatbatch went onto patent the device, which greatly succeeded in the US market during the 1960s (Jeffrey, 2003). It was referred to as the Chardack-Greatbatch pacemaker, and was licensed to a company called Medtronic (Jeffrey, 2003). Between 1961-1963, over 2,000 units were sold by Medtronics (Jeffrey, 2003). Surgeons ended up playing a dominant role in the implantation of these pacemakers up until the 1980s until smaller pulse generators were invented (Jeffrey, 2003). Nevertheless, the pacemaker provided a new approach to addressing health problems and were regarded as prestigious medical devices. The field of pacemaker development continues to be relevant even decades later as it was found in 2016 that globally, over 700,000 cardiac pacemakers are implanted each year (Bernard, 2016).

References:

Bernard, M. L. (2016). Pacing Without Wires: Leadless Cardiac Pacing. The Ochsner Journal, 16(3), 238–242.

Bullock, K. (2006). Samuel Ruben: Inventor, Scholar, and Benefactor. The Electrochemical Society Interface, 15(3), 16–17. https://doi.org/10.1149/2.F02063IF

Fowler, G. (1988, July 20). Samuel Ruben, 88, an Inventor Noted for Electrochemical Work. The New York Times. https://www.nytimes.com/1988/07/20/obituaries/samuel-ruben-88-an-inventor-noted-for-electrochemical-work.html

Jeffrey, K. (2003). Machines in Our Hearts: The Cardiac Pacemaker, the Implantable Defibrillator, and American Health Care. Johns Hopkins University Press. https://muse.jhu.edu/pub/1/monograph/book/3213

Patent Number 2422045, Alkaline Dry Cell, 1947 June 10; Samuel Ruben Papers; RG 015;

Box:1; Folder: 66; Poly Archives at Bern Dibner Library of Science and Technology, New York University.

Salkind, A. J., & Ruben, S. (1986). Mercury Batteries for Pacemakers and Other Implantable Devices. In B. B. Owens (Ed.), Batteries for Implantable Biomedical Devices (pp. 261–274). Springer US. https://doi.org/10.1007/978-1-4684-9045-9_9

The Electrochemical Society. (2014, August 11). Samuel Ruben Archives. The Electrochemical Society. https://www.electrochem.org/ecsnews/tag/samuel-ruben