At the turn of the prolifically inventive nineteenth century, the A.A. Marks Company of New York City took out a newspaper advertisement touting its award-winning artificial limbs. The ad, headlined “LEGS AND ARMS with rubber feet and hands,” featured an illustration of a double-amputee performing a miraculous task:
Climbing a ladder.
“[H]e has two artificial legs substituting his natural ones, which were crushed by a railroad accident and amputated,” the manufacturers explained. “With his rubber feet he can ascend or descend a ladder. He can walk and mingle with persons without betraying his loss; in fact he is restored to his former self for all practical purposes.”
The Marks family founded its medical equipment company in 1853 “for the purpose of relieving and helping the maimed and deformed.” The company sold its patented products—which also included crutches and wheelchairs—by mail order. Unlike clunky, wooden peg legs that hadn’t evolved for centuries, A.A. Marks pioneered a new generation of prosthetics made of rubber. The company hailed the advent of indefatigable Charles Goodyear’s vulcanization process, which allowed it to add a springy, sponge rubber to their artificial hands and feet. Goodyear probably never imagined that the gum elastic he originally used for mundane valves, galoshes, and mailbags would be incorporated in life-enhancing prosthetics.
A.A. Marks also determined through research and experimentation that the key to increasing usability and durability lay in improving the construction of the ankle joints. Within a few decades, the company had custom-fit and sold more than nine thousand prosthetic devices to amputees across the country. Marks’s son, George Edwin, studied civil engineering before joining his father. He patented six important improvements in the design and manufacture of artificial limbs. The Marks family published several tomes and treatises, including the Manual of Artificial Limbs and A Treatise on Artificial Limbs, which became industry bibles. Their technological advancements earned praise from physicians, patients, and scientific panels, including a committee of the Franklin Institute, which honored the inventors with a prestigious medal.
At the 1893 Columbian Exposition in Chicago, the company’s representatives displayed a wide array of fifty different limbs and prosthetic parts. They weren’t alone. “In a testament to the demand for prostheses,” a medical historian reported, “no fewer than nine manufacturers of artificial limbs had assembled on this occasion to display their wares.”
Another family-owned prosthetics firm, the Winkley Company of Minnesota and Wisconsin, later bought out A.A. Marks. Albert Winkley was a farm boy who lost his left leg in a horrible lawn mower accident at age eleven. As a young man dissatisfied with his stiff and painful prosthetic, he invented and patented an adjustable artificial limb with a slip socket. “We began as a result of one man’s struggle to be more comfortable walking in an artificial limb,” Winkley’s president, Greg Gruman, told me. “Given the advances of today’s prosthetics it might seem primitive, but was typical for the time.”
Winkley partnered with savvy businessman Lowell Jepson, who had befriended Winkley after purchasing horses from him. The Winkley Company, founded in 1888, reached out to the railroad industry and offered hope to amputees who had lost limbs in occupational accidents. Winkley covered its willow-wood prosthetics with rawhide leather to strengthen them. Custom-made machines smoothed the wooden parts; workers hand-forged and pounded out steel joints. Women in the knitting department manufactured special stump stockings. Winkley, now in its fifth generation of family ownership, is still in business today after more than 125 years.
The overwhelming number of soldiers who lost limbs during the Civil War—thirty thousand Union and forty thousand Confederate—spurred even more entrepreneurial Americans to put their time and talents into this market. Engineering student James Edward Hanger led the pack. After dropping out of school to join his brothers in the Confederate Army, eighteen-year-old Hanger suffered life-threatening leg wounds at the Battle of Philippi in West Virginia. Hanger had been saddling his horse in a stable when a cannonball ripped through the building and tore through his limb. Leaving a crimson-spattered trail, the desperate young man crawled up to the barn loft to hide. And die.
Union troops discovered Hanger drifting in and out of consciousness while hemorrhaging blood in the hay. Surgeon James D. Robison performed the first battlefield amputation on the young man with no anesthesia or sterilized tools. The Union doctor and his assistants removed Hanger’s shredded limb from above the knee with dirty saws and knives, then transported him to a medical facility.
“I cannot look back upon those days in the hospital without a shudder,” recalled Hanger. “No one can know what such a loss means unless he has suffered a similar catastrophe. In the twinkling of an eye, life’s fondest hopes seemed dead. I was the prey of despair. What could the world hold for a maimed, crippled man!”
Hanger returned home with an unwieldy peg leg and hobbled upstairs to his bedroom. He summoned puzzled relatives to bring supplies—wood, household scraps, tools—and locked himself away. After three months, he fulfilled a promise to himself not to emerge until he could walk downstairs to his family. Triumphantly, he tossed the peg leg aside and descended with ease wearing the “Hanger Limb”—his first-of-a-kind prosthetic fashioned from oak barrel staves, rubber, and metal bits. The design was hinged at both the ankle and knee to improve mobility.
“I am thankful for what seemed then to me nothing but a blunder of fate, but which was to prove instead a great opportunity,” Hanger reflected. He secured several patents, opened up his first store in Richmond, incorporated J.E. Hanger Company in 1906, and vigorously promoted his products to fellow amputees.
Five of Hanger’s six sons joined the thriving business. In constant pursuit of improvement, Hanger traveled to Europe after World War I to study new techniques in amputation surgery. After he died in 1919, the sons, their in-laws, and several cousins turned the family enterprise into a corporate powerhouse. The company gradually expanded to Atlanta, Philadelphia, Pittsburgh, St. Louis, London, and Paris. Government subsidies for disabled veterans brought in lucrative contracts after World War I. But Hanger’s success derived from the founding vision and private initiative of an intrepid teenage soldier who staved off death and hopelessness to pursue his American Dream.
After more than 150 years in business, Hanger Orthopedic Group, Inc., is the oldest and one of the largest prosthetics and orthotics companies in the world—with patient care, manufacturing, and distribution divisions dedicated to “enhancing human potential.” (Prosthetics replace lost limbs and other body parts; orthotics support or correct deformed or damaged limbs.) CEO Ivan Sabel consolidated and modernized the company. With venture capital funding, Hanger made nearly one hundred acquisitions that increased the reach and scope of its device development and distribution. The for-profit conglomerate generated more than $1 billion in revenue in 2013, and employs more than three thousand employees in forty-three states, along with twenty-five offices across Europe. A philanthropic foundation by Sabel supports thousands around the world who have suffered debilitating injuries as a result of disease, accidents, or violence.
Hanger has remained at the forefront of innovation. The Hanger clinics provide devices for infants with head deformities known as plagiocephaly and orthotics for children with cerebral palsy and other conditions. They also supply insoles and footwear for diabetics, neck braces and spinal orthoses for patients with chronic diseases or injuries, burn masks, and postmastectomy forms and bras. At the Northwest Hanger Clinic’s National Upper-Extremity division in Tacoma, Washington, inventor Ryan Blanck is now leading research and development for clients with trauma-related amputations and limb injuries. Blanck cared for hundreds of wounded American soldiers at the Center for the Intrepid, Brooke Army Medical Center (BAMC) in Fort Sam Houston, Texas. While there, he devised the Intrepid Dynamic Exoskeleton Orthosis (IDEO), a carbon and fiberglass ankle-foot orthotic custom-molded for each warrior. Thanks to Hanger’s purchase of Blanck’s patent rights (which he had waived for the military), his products will now be widely available to civilians. He also worked on Segway inventor Dean Kamen’s DEKA Arm System, or “Luke Arm,” with the Department of Defense. DEKA’s robotics engineers have partnered with New England–based Next Step Orthotics and Prosthetics and Southern California–based Biodesigns, Inc., on the project.
The Marks family, Albert Winkley, and James Hanger would undoubtedly be amazed and proud of how far their American successors have taken the industry to improve the human condition. Austin-based Hanger Orthopedics was just one of the U.S. companies supporting victims of the 2013 Boston Marathon terrorist attack. Sixteen innocent men, women, and children lost limbs in the double bombing that sent nails, shrapnel, and metal scraps flying. Two lost both legs. By the first anniversary of the attack, the amputees had each faced scores of surgeries, skin grafts, and grueling rehab.
Eight of the survivors use carbon-fiber sockets manufactured by United Prosthetics, a small, family-owned business in Dorchester, Massachusetts. Italian immigrant Philip Martino, originally a shoemaker, founded the company as United Limb and Brace in 1914 after working at a prosthetic company in Boston. Martino’s two partners were former patients and amputees themselves. Within a decade, Martino had patented a cushioned socket for thigh legs using sponge rubber. Next, he invented and patented a socket improvement for patients with above-the-knee amputations. The sockets connect to artificial knees or other parts manufactured separately by different companies. When Martino died, his World War II hero son took over and established close relationships with local hospitals and nursing homes. A redevelopment push by Boston city officials wielding eminent domain powers forced the company out of its workshop and offices. The resilient family found new digs and kept going. Four generations of Martinos have worked in the business, now based in a two-story brick warehouse in Dorchester.
Dorchester is also the hometown of Jane Richard, age seven, the youngest Boston Marathon bombing victim. Her brother Martin, age eight, died in the attack. Jane also lost a leg from beneath the knee, and now walks on an artificial limb designed by her neighbors at United Prosthesis. The family had never heard of the company until tragedy struck.
There are thousands of unsung private businesses like United Prosthetics humming along unnoticed in small towns across America. Just as the nineteenth century brought inventors out of the woodwork to address the needs of wartime and occupational amputees, so has the twenty-first century spurred entrepreneurial innovation from the depths of adversity. The wars in Iraq and Afghanistan created a new generation of wounded warriors in need of artificial limbs. These days the materials of choice are no longer oak wood, leather, and sponge rubber, but lightweight carbon-fiber composites and advanced plastics.
Who builds them?
Meet the Bally Ribbon Company, just one of countless American companies that supply prosthetic manufacturers with their material foundations. Yarn salesman Herbert Harries founded his Berks County, Pennsylvania–based business in 1923. He built massive looms that wove an eclectic variety of fabrics for garter belts, hat bands, suspenders, and blanket bindings. Harries used his machines to manufacture Purple Heart ribbons and nearly six hundred other types of military decorations. During World War II, the company adapted its industrial processes to produce woven webbing, tapes, and specialty fabrics for the military. Bally Ribbon next diversified from textiles and defense work to aerospace, safety, automotive, and medical applications.
The firm’s design engineering division dove into the composites industry in the 1990s with 2D and 3D structural fabrics. These are advanced textiles that combine disparate materials to add strength without adding weight. Fiberglass, carbon fiber, or natural fibers, for example, can be mixed with plastic resins to create reinforced composites. Bally workers spin nylon, polyester, aramid, graphite, glass, quartz, ceramic, and silicon carbide into watchbands, backpack straps, parachutes, and spacesuit components. The company’s weavers and engineers produce the tubular materials used to make stents and grafts for patients with damaged aortas. They’ve also innovated implantable ligature tape, dental materials, and monofilament material used in blood filtration, aspirating devices, and bone marrow transplants.
In the 1970s, the company developed biomedical webbing and braided carbon graphite materials for the manufacture of the world’s most advanced artificial limbs. Hundreds of employees use everything from original shuttle looms to the most advanced software for manufacturing work. The company installed large braiding machines in the past fifteen years that produce carbon yarn tubular products used for the fabrication of artificial legs. Bally recently celebrated more than ninety years in business and is in its fourth generation of family ownership. When I asked Bally vice president Bert Harries, grandson of founder Herbert Harries, what the company’s secret to success was, he told me: “Our willingness to work and our openness to everything. We never said no to an opportunity.” He added: “American small businesses are incredible generators of ideas, hard workers and wealth for this country. Bally has great people and a next generation that is working hard and interested in continuing our innovative history. Their great-grandpa would be amazed at the technology at Bally today, but it’s probably what he would have expected.”
Another American small business success story, the Willow Wood Company in rural Mt. Sterling, Ohio, shares a similar story of perseverance and evolution. Founder William Edwin Arbogast lost both legs in a railroad accident in 1901. He spent 212 days in a hospital, recovering. Like other amputee tinkerpreneurs, he was unhappy with the state of prosthetic technology. Arbogast used the willow wood grown on his family farm to carve himself better limbs than those available on the market. In 1907, he established the Ohio Willow Wood Company, Inc. The business grew steadily, but the Great Depression forced its leaders to find creative ways to survive. Willow Wood diversified into the manufacture and sale of wooden polo mallets and balls.
The Arbogasts were tested again when a factory fire struck and destroyed the entire company plant in 1933. The founder’s $40,000 in life savings went up in flames with it. But Willow Wood stood fast. The Pittsburgh Post-Gazette reported at the time:
It takes more than the loss of both legs at the knees, the washing away of all his winter’s cutting of valuable red willow and the destruction by fire of his willows wood factory to discourage William E. Arbogast, president of the Ohio Willow Wood Factory here. Although his entire factory was wiped out by fire on June 15, he is already in the field with his products and his new fireproof factory plans are practically complete.
During World War II, Willow Wood made parts for the Navy’s PT boats and the Army’s B-17 bombers. But their core business remains prosthetics. Willow Wood sells products ranging from stump socks to cushion heels to gel liners. Their “vacuum suspension systems” improve the seal between a prosthetic socket and the artificial limb’s liner. The company has also been at the forefront of computer-assisted design and computer-assisted manufacture (CAD/CAM) with its “OMEGA Tracer” system. It incorporates handheld scanners that capture images of a patient’s body and digitize the files, which are then used with milling machines to carve and manufacture parts.
Prosthetics can now be controlled by other parts of the body connected by cables, external motors, and sensors that pick up electrical signals emitted by muscle movements. They no longer clunk and clink. They listen and “think” with embedded microprocessors that gather data on mobility and motility to improve functionality.
Climbing a ladder is kid’s play compared to the activities enabled by modern artificial limbs—from Olympic running to rumba dancing, skiing, and mountain climbing.
There aren’t just one or two large prosthesis makers in America, but hundreds of all sizes and specialties. Many of the new tinkerpreneurs themselves are amputees, just like the leading nineteenth-century prosthetic pioneers. Others are still in their teenage years or barely out of them, just like James Hanger and Albert Winkley before them.
Bob Radocy, who lost his left hand in a car accident, runs an eight-person small business in Boulder, Colorado, called Therapeutic Recreation Systems Inc. He self-financed his start-up in 1979 and now manufactures an estimated one thousand specialized prosthetics a year for clients who have lost hands and arms. “In addition to dozens of prosthetic sports attachments,” the Boulder County Business Report noted, “40 percent of the company’s business comes from prosthetic crawling devices for infants born without hands or feet. The company also makes specialized attachments for individuals all over the world, such as well-known amputee and Boulder resident Aron Ralston, who made headlines after self-amputating one arm after a climbing accident in a slot canyon in Utah.”
The founder of for-profit Flex Foot, Inc., Van Phillips, lost his left leg below the knee after a motorboat collided with him in a grisly water-skiing accident His athletic experience helped propel prosthetics technology into a new era with a deceptively simple insight: The devices, he concluded, needed an energy source. From the hind legs of kangaroos and cheetahs, Phillips observed how limbs store power and muscle energy. He constructed an artificial leg of carbon graphite—stronger than steel, lighter than aluminum—whose springy C-shape stored kinetic energy with every step. Phillips owns more than one hundred American and foreign patents. Users of his famous “Cheetah” legs range from elite Paralympic athletes to grade-school amputee Jane Richard, the seven-year-old Boston Marathon bombing survivor.
As a child, Phillips built his own tree houses and constructed elaborate ice forts. “Anything you can think of, you can create,” the tech titan urges schoolchildren with the enduring optimism of the tinkerpreneur.
Some of the most cutting-edge developments in twenty-first-century prosthetics involve “neural interfacing” with an implanted brain chip and sensor that communicate with robotic limbs. With such a system, quadriplegics may one day be able to control prosthetics with their thoughts. BrainGate, a privately held company based in Boston and Los Angeles, owns more than thirty patents related to neural interfacing technology. A consortium of academic researchers first pioneered the brain-to-consumer interface. One of them, tinkerpreneur Jeff Stibel, used money from the sale of his start-up Simpli.com (an Internet behavior analysis tool), to form a for-profit venture to bring the BrainGate system to market. Blackrock Microsystems LLC, a privately held Utah company, manufactures the implantable hardware. Many of the company’s other devices and tools are driving the “next generation of such key areas as auditory prosthesis, bladder control, pain, epilepsy, pharma research, and treatments for arrhythmia and heart failure.”
MIT researcher Hugh Herr started his own company, BiOm, which manufactures and sells the “world’s first bionic foot-and-calf system.” Herr is a double amputee who lost both legs in a climbing accident. MIT described how his invention works:
Using battery-powered “bionic propulsion,” two microprocessors and six environmental sensors adjust ankle stiffness, power, position, and damping thousands of times per second, at two major positions: First, at heel strike, the system controls the ankle’s stiffness to absorb shock and thrust the tibia forward. Then, algorithms generate fluctuating power, depending on terrain, to propel a wearer up and forward. . . .
Among other things, the system restores natural gait, balance, and speed; lowers joint stress; and drastically lowers the time required to acclimate to the prosthesis (which can take weeks or months with conventional models).
Boston Marathon attack survivor and professional ballroom dancer Adrianne Haslet-Davis, who lost her left leg below the knee in the bombing, demonstrated Herr’s system in an unforgettable way: Near the end of Herr’s presentation at a TED (Technology, Education, and Design) talk in Vancouver, Canada, in March 2014, Haslet-Davis took the stage with her dance partner. Dressed in a sparkling white minidress, she performed underarm turns, hip rolls, dramatic dips, and open breaks in a sensual, rhythmic rumba.
In less than a year, Herr reported, he and his team had programmed Haslet-Davis’s prosthetic to perform the fundamentals of dance: “In 3.5 seconds, the criminals and cowards took Adrianne off the dance floor. In 200 days, we put her back.”
Herr is passionately committed to the successful commercialization of his ideas. BiOm continues to develop new products with an estimated $50 million in grants and venture capital from firms including WFD Ventures, General Catalyst Partners, Sigma Partners, and Gilde Healthcare Partners. “I’m always thinking about minimizing the time and investment to get from bench to bedside,” Herr has said. “Starting a company is one way of enhancing that efficiency” and fueling “commercial progress.”
Not just one way. The best way. As Nobel Prize–winning economist Milton Friedman summed up human experience: “So that the record of history is absolutely crystal clear: There is no alternative way, so far discovered, of improving the lot of the ordinary people that can hold a candle to the productive activities that are unleashed by a free enterprise system.”
America’s brightest young minds are now at work on their own patented solutions and improvements in prosthetics.
At age sixteen, Katherine Bomkamp, daughter of a retired Air Force colonel, invented a pain-free socket using the concept of thermal biofeedback to help eliminate the problem of “phantom pain” in amputees. She was exposed to the issue while she and her father visited Walter Reed Army Hospital in Washington, D.C. The condition occurs when the brain continues to send signals and commands to missing limbs. “I started looking into what phantom pain was,” Bomkamp explained, “and quickly found that there was no medication available on the market for treatment.” Commonly prescribed antipsychotics and barbiturates cause serious side effects. “For my tenth-grade science project that year,” Bomkamp says, “I decided to do something about it.”
Bomkamp theorized that using controlled heat to stimulate an amputee’s severed nerve endings would divert the brain into concentrating on the temperature instead of sending the signals that caused phantom pain. She cold-called prosthetics experts and forged a relationship with Jake Godak of wholesale distributor Cascade Orthopedic Supply in California. He built the first socket and prosthetic leg based on her ideas. Bomkamp secured a patent on her invention and established her own company, Katherine Bomkamp International LLC. Katherine told me, “Securing the patents has been absolutely vital.” She has retained a patent attorney and is licensing her invention as “the best route” to get it to market. Her advice for budding tinkerpreneurs? “Surround yourself with people who know more than you do. I found mentors in the industries I wanted to work in, and they added a lot of credibility to what I was trying to do.”
Massachusetts Institute of Technology student David Sengeh, twenty-seven, has a patent pending on artificial limbs using magnetic resonance imaging and 3D printing. A grad student at MIT’s Media Lab, Sengeh began working on prosthetic socket design as a result of his experience growing up in war-torn Sierre Leone, where brutal terrorists chopped off innocent civilians’ arms and legs to induce fear and quell civil unrest. Sengeh plans to start his own company.
Eric Ronning designed a 3D printable prosthetic hand while a junior mechanical engineering student at the University of Wisconsin–Madison. He started his own company, called “Re,” to manufacture the low-cost devices he calls “ReHands.”
And then there are the Girl Scouts in Iowa who call themselves the “Flying Monkeys.” In 2011, they secured a patent for a low-cost prosthetic hand made of Lego building blocks. The girls, ages eleven to thirteen, created the device for a three-year-old toddler born without fingers on her right hand. Dubbed the “BOB-1,” the scouts’ invention is made of moldable plastic, Velcro, and a pencil grip—all at a cost of ten dollars to build.
“I think it would be cool if we had, like, our own company and then we made BOBs,” twelve-year-old Zoe Groat, aka “Monkey 1,” told ABC News.
“I hope to make lots of them,” twelve-year-old Gaby Dempsey (“Monkey 3”), added. “It could go nationwide. A lot of people could use them. It would help people.”
“It’s a really big deal to be getting a patent,” thirteen-year-old Kate Murray, aka “Monkey 2,” explained to a reporter. “Almost no one at our age has one and it’s very special. It means our invention is really worth it.”
Young Kate is right. America’s patent process is a “big deal” indeed. As the stories of the successful tinkerpreneurs in this book illustrated time and again, the securing of patents and protection of intellectual property were critical keys to commercial success—and will be essential to securing America’s inventive future.