CS_F2012_03

Codes and Standards Fall 2012 Session · 12 sections 9 cases · Watch on YouTube ↗ all files
Layer 3 — readable edition

§1. Helicopter rotor mechanics: collective, cyclic, and the swashplate [00:01]

§1.p1

Questions? We were talking yesterday about making measurements and the precision of parts per thousand, parts per million — that you can measure mass, length, and time more precisely than anything else.

§1.p2

I'm going to start today by telling you what they'd call at Harvard Business School a case study, about a product that has some very precise manufacturing tolerances and what you have to do to achieve them; what happened when the company screwed up; why they likely screwed up; how someone else blamed the next failure that occurred — which killed a couple of people — on that same cause, even though it wasn't the same cause. And how, after the fact, you can make a measurement of something that's virtually completely destroyed and still get some idea of whether it really had the manufacturing dimensional defect or not.

§1.p3

It has to do with the helicopter swashplate. Did anybody know what a helicopter swashplate does, or is? [Tom shows an image of Igor Sikorsky's 1939 helicopter.] Here's Igor Sikorsky in 1939 flying his first working helicopter, and up here there's a mechanism. Obviously you don't want the passenger compartment to rotate, you want the blades to rotate, so you have to have a stationary plate and a rotating plate that come together. It's called a swashplate.

§1.p4

In the old days it basically was a spherical dish that was stationary and another spherical dish on top, and you just greased the whole thing up. Two saucers, one rotating inside the other with a bunch of grease. Now we use bearings rather than the early grease-and-dish design. If you think of the plate, it can be rotated in the x or y direction, and that gives you control for two things on the rotor blades.

§1.p5

One of the things you want to do is take that rotating disc and change the angle of attack of each blade as it's going around. You want to tilt the blade up to a higher angle if you want to go up, tilt it down if you want to lose height, keep it at some intermediate level to maintain height. And you also want to go right or left. The first one is called collective — you collectively move all the blades with the same angular rotation to give you more lift up or less lift down.

§1.p6

The other one is called cyclic. The pilot has a lever for the right hand and a lever for the left hand. If I remember, the left hand is the collective that allows you to go up or down, and the cyclic allows you to tilt the rotor disc. If you want to go forward it tilts forward, to go right that way, to go left that way, to go backwards you tilt it back.

§1.p7

So the cyclic is the angular orientation of the rotor disc, and the collective is the actual angle of attack of each individual blade. You can have up to seven blades — there's actually a Soviet helicopter that has eight — and they collectively all get the same angle in collective. The pilot is controlling the main rotor with his two levers, collective and cyclic, and his two feet are controlling the rear.

§1.p8

This one's a NOTAR — no tail rotor. Normally you have a little blade back here, because you've got friction in the system and the thing is going to start to spin if you don't have some restoring force to keep it heading in the same direction. In fact, if you lose that tail rotor, the thing will start spinning out of control and crash. A NOTAR has a great big fan — well, about this big — that blows air out the side as the counteracting force to keep the thing from rotating. So it simplifies the mechanics. The tail boom is just a tube, whereas a conventional tail boom has bearings and shafts and all kinds of things that can fail.

§2. The Mach-1 blade-tip limit and the V-22 Osprey [05:35]

§2.p1

Student: [Question about helicopter speed limits.]

§2.p2

They didn't change the speed. The speed of the helicopter is limited by the speed of the advancing blade. Some blades are clockwise from the top, some are counterclockwise — you can design them both ways. But the limiting speed is when this blade tip hits Mach 1. You can't go any faster, because you have to break the sound barrier. At that point you start getting all kinds of instabilities and vibrations, and typically you'll rip your blades apart.

§2.p3

Down in Hampton, Virginia, there's a NASA facility where they do test flights, and they have a helicopter out there. NASA once flew a helicopter that had more than Mach 1 blades. Typical helicopters might be limited to 200 miles an hour — they can't go 250 miles an hour because you'll rip off the blades from the vibrations of trying to break the sound barrier. You get a sonic boom and all kinds of vibrations.

§2.p4

That's why the V-22 Osprey, the Marines' sixty-million-dollar tilt-rotor helicopter, can go 300 miles an hour — because it can tilt. The rotor blades are now in airplane mode, so you don't have the additional velocity of your forward motion, you just have the tip speed. The receding blade is always going less. One blade is going plus your forward motion, the other at the three o'clock position is minus your forward motion. No problem with the receding blade — it's the advancing blade that will set up instabilities and vibrations that'll crash.

§2.p5

NASA once did it with a big jet engine off the back of an experimental helicopter. If you go down there, it's sitting out in the lawn in front of the administration building. It was unsafe to fly. They did it because someone wanted to see exactly what happens when you start breaking the sound barrier with your blades, plus all the noise — and helicopters are noisy enough.

§3. The Japanese Maritime Self-Defense Force crash [08:29]

§3.p1

But I don't want to get into all the physics of helicopters. What happened was: the Japanese Maritime Defense Forces — the Japanese Navy — by their constitution, the Japanese are not allowed to wage an offensive war anymore. We wrote the constitution for them in 1945. This is a big deal for the Japanese, they're very proud of the fact that they only have defense forces. So their military is called the Defense Forces.

§3.p2

One of the Japanese Navy helicopters crashed in the Sea of Japan, about five or ten thousand feet of water. Took a long time to get it up. The swashplate just seized up — the bearings seized up. It was down in the ocean for so long that by the time they got it up it was so corroded they couldn't quite tell. It was the first time anything like this had happened, even though this type of helicopter was first designed in 1964 or '71. They hadn't had failures until this one in the late '80s.

§3.p3

And plus, it was Japanese people — within the U.S. defense community, it's kind of, well… if it was a U.S. soldier that died you see this even in Afghanistan, right. It's a big deal if an American soldier gets killed by a terrorist, it's not as big a deal if an Afghani gets killed by a terrorist. That's just the way it is.

§4. The Cherry Point crash and the rigged board of inquiry [10:19]

§4.p1

[Tom shows a photograph of the swashplate assembly.] Here's the swashplate. It's a very complex assembly. This is one of the linkages, there's another linkage. When the swashplate tilts — this is either collective or cyclic — there's a bearing inside here. The bearing failed, and it failed on an aircraft that was on its initial two-hour flight. It had just been built, it hadn't been turned over. There was no DD-251 form — that's the standard form that transfers ownership from the contractor to the government. A one-page form, so you have a point in time of who owns that helicopter.

§4.p2

One of the performance specifications was that every helicopter has to fly in a hover for two hours before you can sell it to the government. So they had these two test pilots doing their two-hour hover above the field. They weren't going anywhere, just hovering for a couple hours. Then it crashes, the guys are dead. They look at it afterward — the swashplate bearing seized up.

§4.p3

So politically — and a lot of the story has to do with the politics, not necessarily the measurements or the mechanics — the Navy said, "This was going to be a Navy helicopter. Since we haven't gotten the transfer of ownership, this really belongs to you, helicopter manufacturer, and therefore you can do your own board of inquiry." Ordinarily when you have any crash of any military aircraft — this is a forty-million-dollar helicopter — there's a board of inquiry. Why did we just lose forty million dollars worth of taxpayer equipment? The Navy said, "We didn't lose a thing. We didn't own it. You owned the loss."

§4.p4

So the helicopter company forms their own board of inquiry. Even though everybody knew it was a bearing failure, they would not allow the bearing company to participate. Ordinarily when you have a failure like this — even in civilian aircraft — the National Transportation Safety Board goes out and forms a team: the owners of the aircraft, which could be Delta or US Air; the manufacturer, Boeing or Airbus; if it's the engine, Pratt Whitney or General Electric. They bring in a team of experts who manufacture the different components, and they all get together to figure out what happened.

§4.p5

In this case, they knew it was a bearing failure, but they wouldn't let the bearing manufacturer participate. They didn't have to, because you didn't have the Navy chairing the board of inquiry. Who did you have heading it up? They had a helicopter company engineer, but the guy who was really running it — they put the lawyer for the helicopter company on the board of inquiry. They had to have public meetings where a court reporter was transcribing. Whenever they got to anything interesting in this three-week investigation, the lawyer would say, "We should go off the record."

§4.p6

So anything of any interest because of the failure was off the record, and there's no transcript. There was no one watching the hen house, and the fox was in the hen house. They had the attorney on the board. Sounds rigged. It is. Just letting you know how things work.

§5. The Reali-Slim bearing and closed conformity [14:22]

§5.p1

[Tom shows a cross-section of the bearing.] The bearing is what's actually called a Reali-Slim bearing, made by Kaydon. These things go in not only helicopters, they go in CAT scan machines at hospitals. This particular one was 40 inches in diameter with a one-inch cross section and half-inch balls. If you looked at the cross section, it was one inch by one inch — outer race, inner race, and the ball was a half-inch ball.

§5.p2

They've made thousands of these for lots of applications, and this was the largest one anyone in the world made — they were a sole source. There's a company in Germany that makes something similar, but not exactly like this. The prior history: yes, they'd had a failure of the swashplate on a Japanese helicopter. This was the second failure they had ever had, and they'd been producing this helicopter for twenty-five, thirty years. So this was sort of a new type of failure, and they didn't even know it was related to the Japanese failure until they started their board of inquiry. They said, "Oh, we had one of these helicopters go down in Japan, let's go over there." They flew over to Japan, saw the pieces, and said, "Oh, that was a bearing failure too."

§5.p3

They started looking. At one time the company had manufactured six bearings — these bearings went for forty thousand dollars apiece, or a hundred thousand dollars apiece, they weren't cheap bearings — and one of them started creating some vibration. They took it off and looked at it and it had what's called a closed conformity.

§5.p4

What's a closed conformity? [Tom shows a generic bearing diagram.] This is an open conformity. You want the balls to roll and ride at the bottom of the groove. The rounded groove has a larger radius than the ball. A closed conformity — I couldn't find one anywhere because no one ever makes these intentionally — is one where the ball has a larger radius than the curvature of the groove, and it's riding on the edges. Not a good idea. A lot of sharp contacts, stresses, and you wear out those edges. That's what caused the vibration.

§5.p5

One of the six bearings that had been manufactured had a closed conformity. Someone in the military found it, wrote it up, and there's all kinds of documentation. The Navy went and started inspecting other things, but they decided it was just a one-of-a-kind. Why was there a closed conformity? When you've got something as flexible as a 40-inch diameter ring that's only one inch high and even less in thickness, that's pretty flexible. If you just had the outer ring or the inner ring, you can actually turn it into a potato chip shape with your own wrist.

§5.p6

That bearing is pressed into an aluminum housing, which is the upper swashplate. That aluminum housing is milled on a vertical boring mill. The thing that gives the shape to the bearing is the swashplate aluminum housing. The helicopter manufacturer manufactured that big aluminum housing themselves, and they just never bothered to look into the shape of that housing — and in fact they destroyed it. Not only that, about six months after this whole inquiry started, they destroyed the three-year-old milling machine that had made it. There was no way to go back and prove what happened to this aluminum housing.

§6. Precision tolerances and matched sets [19:01]

§6.p1

The tolerances we're talking about: the diameter of that 40-inch bearing is supposed to be 40 inches plus or minus 2 thousandths. If it's four thousandths total variation out of forty inches, that's one part in ten thousand. And what did I tell you yesterday? A typical manufacturing tolerance is one part in two thousand for machining or measuring something. If you've ever worked in a machine shop trying to turn the diameter of something to one inch on a lathe, it's hard to hold anything better than half a thousandth. You can grind it and lap it and get down to a tenth of a thousandth, but if you're doing that you now have to start specifying the temperature at which you made the measurement. And the tools that you're measuring with, which also are steel, have to be at the same temperature.

§6.p2

When they grind this bearing at Kaydon, the whole thing's in an automatic grinding machine. You set it up and jig it, and the grinder goes around and grinds the grooves on the diameter, making sure everything's as spherical as possible. They actually take the micrometer — the whole thing is flooded with oil while the machine's running, as lubricant and coolant — and put the micrometer right there on the bed of the vertical boring mill, bathed in the same bath of oil. When they measure it, they're measuring with the tool at exactly the same temperature. Who cares if it's 66 degrees or 72 degrees, as long as the two tools are calibrated and at the same temperature, you'll get a valid reading. They're trying to hold one part in ten thousand, which means you've got to be within about two degrees Fahrenheit of the same temperature.

§6.p3

That wasn't how they caused the closed conformity. The balls are not just half-inch balls, they're 0.500 inch to 50 millionths of an inch. They've got to run true in this 40-inch bearing, and actually as you get to larger diameters, the need to run true gets greater and greater even though you're getting larger. You're heading in the wrong direction, which is one of the limitations on the ability to even manufacture bearings this thin and this small.

§6.p4

So the ball diameter has a total tolerance of 50 millionths — plus or minus 25. Now this is tighter than one part in ten thousand. This is one part in twenty thousand.

§6.p5

How do you do it? You can't, even by lapping — if you put a bunch of balls on the lapping table, they will not come out with that type of tolerance. And you had to have 192 balls with that tolerance — 192 is the number around this 40-inch circle. So how do you do it? There are many cases in manufacturing where your tolerance required is tighter than anything you can manufacture the individual part to. What they do is they make matched parts. You make a bunch of parts, pick this one and measure it, pick that one and measure it, and you put the two of them together in matched sets.

§6.p6

They make 50,000 balls, then they sort them: which ones are half an inch exactly, which are fifty millionths under, which are twenty-five millionths under, which are fifty millionths over. They group them into sets.

§6.p7

If you go into Kaydon's shop, or a Pratt Whitney shop — the two places I've been — they have micrometers that look like a lathe to measure a half-inch ball. It's sitting on the floor, the size of a small lathe. The room is temperature- and humidity-controlled within one or two degrees. There's a person sitting there putting the half-inch ball in the micrometer of this great big machine that's got all these compensation mechanisms to measure something that small reproducibly. Someone sitting there making minimum wage, measuring each ball, putting them in different bins. Here's a set of 192 — or they might actually make it a set of 200, in case someone lost one — that will go into the assembly room, where they have the two rings ground as a matched set to about four thousandths. Then they put the balls in based on a more precise measurement of the actual grooves and the shape of that groove. If I only had to do it to a tenth of a thousandth, no big deal, but when I have to do it to a half a tenth of a thousandth, I have to use matched sets of balls.

§6.p8

So how did this closed conformity out of six bearings ever occur? Someone probably picked up or mislabeled a set of balls and assembled them in there. There were other inspectors who should have caught it before it went out, but they didn't, and it got out, started vibrating on a helicopter, and they caught it. No one got hurt.

§6.p9

The inspectors for the government — we're going to talk later about inspectors — each individual employee is supposed to be their own inspector with a little "i", then the company has their own inspectors with another little "i", and then the Navy has someone full-time in that plant and they're the capital "I" inspectors. But they don't really do the inspecting, they're just checking on the quality control, doing quality assurance. They're not checking every part.

§7. The fleet grounding and the Grenada aircraft carrier digression [26:44]

§7.p1

Until this one went down at the helicopter company and killed two test pilots. Now the helicopter company says, "Oh, we have one like this in Japan." And the Navy down at Cherry Point has a pilot with one of these helicopters coming in for a landing. As he's about two feet off the ground, his swashplate seizes and he slams two feet down. Nothing happened, but it was a seizure. They take it apart and say, "We had a bearing failure." And all of a sudden within the next few months they had four or five bearing failures, and they grounded the whole fleet.

§7.p2

If you want to see an admiral or a general in the military really upset, ground the whole system for the entire world — because now that part of your whole defense scheme is not operational. I had a situation once where an aircraft carrier got pulled back into port because of some bad welds they'd just made on the steam system. This was right as they were starting the invasion of Grenada — we invaded Grenada like 25 or 30 years ago. They had waited for that aircraft carrier to get out of Philadelphia Naval Yard before they started the invasion, because at that point they were going to use the other aircraft carrier in the Atlantic for the invasion, and they had to have one to protect against the Soviet preemptive attack.

§7.p3

They start the invasion — the one aircraft carrier gets out of Philadelphia Navy Yard, president says okay, go invade Grenada — the invasion took like a week. But a couple days in, they find they have steam leaks in the engine compartment of the aircraft carrier that's defending the entire North Atlantic. They have to go into Jacksonville Naval Shipyard for emergency repairs. All of a sudden we have no aircraft carrier defending the North Atlantic, and if the Soviets wanted to attack, that's the time to do it.

§7.p4

I talked to some of the guys in the Navy who were charged with going down to Jacksonville and fixing this. They were getting phone calls at 2 a.m. at home saying, "A helicopter will land on your lawn at 3 o'clock, be on it." They were being ferried from home to Jacksonville, Florida, to start working on fixing this aircraft carrier. When the military needs to move, they can. That's a true story.

§8. The FBI takeover at Kaydon and a perfect bearing that still failed [29:39]

§8.p1

So this whole fleet of — I'll just call them heavy lift helicopters — was grounded, and the admirals are going berserk. The helicopter company, who knows it's a bearing failure and doesn't want it to be their bearing failure, tells the government, "Oh, Kaydon did a terrible thing, they made a closed conformity, this must have been another closed conformity bearing." Well, how many times is someone going to pick up the wrong bag of balls? That was sort of a one-of-a-kind thing. But the government doesn't know necessarily.

§8.p2

All of a sudden the FBI gets called in. Criminal investigation. Every bearing at Kaydon of this type was impounded, and they invoked the Emergency Powers Act, which says the government can come in and take over your manufacturing facility in a national emergency and put everything on number one priority to fix the problem. All your other commercial orders take a back seat. If you have time to manufacture something else, fine, but we're going to have FBI agents and government inspectors next to every one of your manufacturing employees making sure the government parts get out the door first. That's the law, because of national security.

§8.p3

So the government took over the Kaydon plant in Muskegon, Michigan, and started making new bearings absolutely perfect to spec. You had all the Kaydon inspectors, the government inspectors — these things got inspected fifty times more than any regular bearing — and they were certified by both Kaydon and the U.S. government that they met every single standard and specification, and the FBI was there to make sure they were ready to put handcuffs on anybody who didn't cooperate.

§8.p4

They put some of these new ones in the field. These bearings were better bearings — none of the manufacturing defects — and they put them into the helicopters. They had to manufacture a thousand of these. All these things go out there, and guess what? Within two months one of them fails. One of the good bearings fails. But it was perfectly within spec, and these things have been flying for thirty years. What had happened?

§9. 188 witness marks: proving open conformity [32:36]

§9.p1

I was brought in not as part of the criminal investigation, but at this point the helicopter manufacturer decided, "Well, we lost a 30- or 40-million-dollar helicopter, we're going to sue Kaydon." The dead pilots are going to sue Kaydon in criminal court. And the FBI has impounded all the evidence. And we're going to sue Kaydon in civil court for the loss of the helicopter, because the Navy didn't buy it, we still owned it.

§9.p2

Kaydon settled the criminal case very quickly — criminal cases are not things you want to defend yourself against when the government's going after you. In a criminal case they sort of have the upper hand. They settled that one for about 15 million dollars with the families of the two pilots. But I was there to figure out: did this thing have a closed conformity?

§9.p3

When it seized, it seized because it was generating too much heat. The aluminum housing — aluminum will absorb a lot of heat — when it crashed and landed, the heat started to soak back into the steel bearing. The aluminum housing's 20 or 50 times the mass of the steel, and it soaked back and just pressed the balls against the races. Everything was overheated, deformed, and we're supposed to go in there and figure out whether these things are accurate to 50 millionths of an inch. That's pretty much impossible.

§9.p4

That's what the helicopter manufacturer was depending on — that no one could figure out whether this was a closed conformity. They're going to use the history that there had once been a closed conformity a couple years before — that never caused a big accident — to say, "Oh, they did it again, shame on them. Pay the pilots 15 million, we want another 15 or 20 or 30 million for our destroyed helicopter. And FBI, oh, it's terrible what this bearing manufacturer has done to us and to the government, you should consider further criminal action."

§9.p5

What are you doing, helicopter company? They're the sole source. If the FBI leaves and says no longer a national emergency, and Kaydon says, "We don't want to do business with you" — you can't ever make another helicopter, because there's no one else in the world who knows how to make these bearings. This is the problem when the attorneys in the company start running the business. They don't worry about the long-term consequences of not working with your suppliers. They just want to show that for their annual bonus they collected a lot of money for you.

§9.p6

So we went out to Muskegon, Michigan, for several days. There were a couple of bearing experts with me; I was the metallurgist. We couldn't look at it without an FBI agent in the room. We couldn't touch a thing unless he was there, because they were still considering criminal action.

§9.p7

We looked at it for two days, trying to see whatever the patterns were. Finally at the end of the second day, I sort of looked at the forest for the trees, and I said, "There's no closed conformity." I had 188 measurements that proved there was no closed conformity on this bearing.

§9.p8

The way I did it was: if you think about how a bearing ball sits in the races, it actually forms a little elliptical contact surface. When you embed the ball — it's called brinelling, when you embed the ball in the race — it forms an elliptical wear mark, an impression. It's just a hardness test. If it had been a closed conformity, what would you have had? An hourglass. The railroad tracks would be on the edges, and we had been looking at those edges for a day and a half, trying to say — but it was so beat up, some parts of it got to eight or nine hundred degrees centigrade and transformed.

§9.p9

So we had been looking at the races, trying to figure out whether it's closed conformity, contacting in the bottom or on the edge. I started looking at the wear marks in the bottom. If it's an open conformity, you get an ellipse. If it's a closed conformity, you get an hourglass, because it's contacting at the edges. When the ball embeds into the piece you'd form an hourglass. We didn't. There were four of them you couldn't even tell, but of 192, 188 you could see a nice little ellipse. There's no hourglass there.

§9.p10

From the shape of that ellipse we probably could have calculated exactly what the conformity was. I was all excited — we're going to take that helicopter company, we're going to stick this down their throat. That night, the big-shot name on the letterhead attorney from the law firm that hired me came in, and the brand-new president of Kaydon came in, and we all went down to dinner on the waterfront of Lake Michigan, about 20 people between all the experts and the attorneys.

§10. The settlement and the potato-chipped swashplate [38:43]

§10.p1

I'd explained to what I call the outhouse attorney — they have in-house attorneys who work for the company and outhouse attorneys who are private attorneys — that day, I had showed him how we could prove this was not a closed conformity. There's no doubt — I had 188 witness marks and they all said 100% this is open conformity. I figured he would explain this to the in-house attorney for Kaydon and the new CEO of Kaydon. They talked about the criminal case and everything, having their attorney dinner conversation.

§10.p2

What happened is, Kaydon settled the case with the helicopter manufacturer for another 15 million. This is an important lesson: the new CEO — this problem had not occurred on his watch, and he was going to get rid of it at the beginning of his new watch. He didn't care what it cost to get rid of it, he didn't care whether he was right or wrong, he just wanted to get rid of it. So he bought his way out, because he could blame it on the previous CEO.

§10.p3

So I spent three days in Muskegon, Michigan, for nothing, to figure out what happened. But in fact we did know what happened. We were looking — could we measure anything? This thing had been cut up into little pieces by the helicopter company. It was no longer circular.

§10.p4

We said, well, why did it fail? We looked at those wear marks, and you could break the wear marks into four quadrants. Two quadrants had deep elliptical impressions, and two quadrants opposite each other had shallower witness marks. One of the other bearing engineers said, "Swashplate had to be potato-chipped." If you put a perfectly spherical bearing into a swashplate that has a potato chip shape, that potato chip ends up creating a minor axis and a major axis. It's effectively a little ellipse, and it's going to get deep impressions on the minor axis and smaller impressions on the major axis.

§10.p5

So we started looking — where are the other swashplates that were machined just before and just after this one? In an aerospace fabrication operation they can tell you by serial numbers exactly which part was made on what day. We knew all the brothers and sisters of this swashplate. But mysteriously they had all seemed to have evaporated. The helicopter company had gone out over the previous two years and for various reasons determined that these swashplates needed to be replaced, kind of on a one-by-one basis, until they were all gone. They didn't exist. We said, "Well, where are they?" "It was government equipment." They'd taken them back and scrapped them.

§10.p6

We said, "Well, we want to see the milling machine that produced these swashplates." "Oh, that was three years old, it was too old, we scrapped it three weeks ago." A three-year-old, quarter-million-dollar milling machine, and they scrapped it. You don't think the helicopter company knows what happened? They knew exactly what happened. They had a milling machine that was out of spec, machined a potato-chipped swashplate. The Reali-Slim bearings took the shape of the swashplate. They did their own investigation. The fox was watching the hen house.

§10.p7

There should have been a criminal investigation, but not of Kaydon — of the helicopter manufacturer. That's why I haven't told you the name of the helicopter manufacturer. Did you tell the FBI about that? We didn't tell the FBI. It's not for me to start telling the attorneys how to manage the whole thing. The guy who's going to decide this at Kaydon, he wants to get rid of it. He wants it off his watch. The last thing he wants is a continuing investigation.

§10.p8

Just as another point of fact, the military is not as stupid as the helicopter manufacturer. The helicopter manufacturer is willing to throw their monopoly bearing manufacturer under the bus. The U.S. Navy is not going to throw their monopoly helicopter manufacturer under the bus. They could run an investigation, and they would probably find, "Oh, the evidence is not available." Well, who made the evidence not available? Duh.

§11. How investigations should work — and the V-22 Osprey court of inquiry [44:16]

§11.p1

This little story has a number of parts about precision measurement, but mostly it's one about how the system works. Ordinarily, if this had been a military helicopter, there would have been some Navy captain or Marine major in charge of the investigation, and they would have found the problem, because they would have invited the bearing manufacturer to participate. Someone would have said, "Oh, what about the swashplate?" Whenever those things came up — and they probably did come up at the meetings of the board of inquiry — that's when they went off the record.

§11.p2

We could read those transcripts and see, well, someone might say, "We ought to look into this swashplate," and then they go off the record. But in a regular investigation, when you don't have people trying to cover something up, it would have been run properly, and maybe justice would have been done.

§11.p3

I could tell you half a dozen stories in different industries. One, big forgings for ships, where a company got screwed by another company. I did have the opportunity, about 20 years later, to screw that company that screwed the other company, just by chance. I could tell you on the V-22 Osprey how that court of inquiry was rigged. They were told they had to find something that could be easily fixed — this may be on one of the other videotapes, so I apologize. The Marine lieutenant colonel, or maybe a Navy captain — the guy who headed up the board of inquiry for the V-22 Osprey Ship Four crash — told someone in a bar one night that they were told they had to find something that could be easily fixed so Congress wouldn't scrap the 40-billion-dollar program. So that one was rigged.

§11.p4

They came up with a fault, they blamed it on the helicopter company, got sued by six widows. They settled with the two military widows very quickly. They offered settlement to the other four widows right before the trial — two million dollars apiece — and two of the widows said, "Okay, we'll take it." The other two widows were advised by their attorneys, "No, we'll get you 40 million dollars." And they lost. In fact, the four women of the jury in Philadelphia said that I was the one who convinced them that it was not a fire in the nacelle, it was a hydraulic leak in the upper nacelle.

§11.p5

Afterwards the Judge Advocate General of the Navy came in, looked at the court testimony, did another investigation after the court of inquiry that included Boeing and Bell and a couple of other companies. They revised the report and adopted the theory that I had. Because the Navy's original theory required six miracles in sequence for the crash to occur. My theory only required one miracle.

§11.p6

The point of that is: you never have all the pieces. You have to figure out what pattern explains the most pieces of your puzzle. That's part of what engineering is. In the mid-'80s I went to a retreat down on the Cape with the School of Engineering, and they tried to define what engineering is. They came up with a definition, which is probably still in the records over there. An engineer deals with complexity and ambiguity and solving problems.

§11.p7

You rarely have a set of facts where everything just fits in perfectly, and if you do, then you don't need people to be fighting over it, because it's obvious. If all the facts fit, anyone can look at it. Most of the time you're dealing with a number of conflicts, and you have to figure out which one makes the most scientific sense. That's part of what an engineer does.

§12. The word "engineer": from war machines to civil engineering at MIT [49:35]

§12.p1

I've got a couple minutes, so I can give you my story — I don't know if you've ever heard it before, it may be on another tape, I give it all the time — of the history of the term "engineering." Anybody know what the word "engineer" comes from? Engineering in this country only goes back a couple hundred years. The word comes from the French — if you look in the Oxford English Dictionary, you'll see it comes from the French ingénieur, which begins with an "i," which, as Professor Sataway [Saadeh?] would say, comes from the Latin root for ingenuity. But an engineer before 1800 was basically a maker of war machines.

§12.p2

The first engineering school in this country was West Point, 1790-something — 1797 or '92 — and they trained military engineers. In 1823, the second engineering school in this country was Rensselaer Polytechnic Institute, in Troy, New York. They were creating engineers to help build what was the big construction project in New York in 1823 — the Erie Canal. They needed people to dig the canal and build bridges and dams and locks. They created a curriculum of engineering different from the military engineers who built breastworks and catapults. They called it civil engineering to distinguish it from the only type of engineering that existed before that, which was military engineering.

§12.p3

There were other schools — Michigan claims to have engineering in the 1840s, but I don't know how many bears in Michigan in 1840 were going to university and studying engineering. In the 1860s, MIT actually started to differentiate. What's Course 1 at MIT? Civil engineering, because that was the only type in addition to military engineering. MIT decided to break it up into other disciplines. One was mechanical, that's number two. Number three is mining — not mining and metallurgy, that didn't enter until 1888 — it was mining engineering. Coal mines, copper mines. Four was architecture. Five, I think, was chemistry. Six, I don't know what the original six was. Electrical engineering didn't start until the 1880s, after Edison and Westinghouse gave us a ready source of electrons.

§12.p4

MIT also defined the field of chemical engineering back in the 1880s, nuclear engineering in the late 1940s — we were the first. A number of the fields of engineering — aerospace engineering, we had the first aero department; aeronautics, there was no astro department originally. Hunsaker, in like 1917, started an aeronautical department. MIT has actually defined a number of the fields of engineering. Not all of them — we didn't define electrical. But anyway, okay, I'll see you Monday.

Cases referenced

  • Japanese Maritime Self-Defense Force helicopter swashplate seizure §3.p1

    The first known failure of the Reali-Slim swashplate bearing — a heavy-lift Navy helicopter crashes in the Sea of Japan, late 1980s. Spends years on the ocean floor, recovery too corroded to diagnose definitively. Sets up the U.S. failure to come.

  • Kaydon bearing conformity failure and helicopter crashes §4.p1

    The most fully developed version of this case in the corpus. Two U.S. test pilots killed during a two-hour acceptance hover; subsequent Cherry Point near-crash; fleet grounding; FBI takeover under the Emergency Powers Act; perfect new bearings still failing within two months; Tom's forensic discovery that 188 of 192 brinelling marks are ellipses (open conformity), not hourglasses (closed conformity); the potato-chipped aluminum swashplate as actual cause; the helicopter manufacturer's destruction of the milling machine and sibling swashplates; the new CEO's decision to settle anyway for $15M to clear his watch.

  • USS aircraft carrier steam system weld failure during Grenada invasion §7.p2

    Digression illustrating military urgency. The Atlantic carrier defending against Soviet preemptive attack develops steam leaks mid-invasion (October 1983); emergency repair at Jacksonville Naval Shipyard; technicians flown in by helicopter from their homes at 3 a.m.

  • V-22 Osprey Ship Four crash and rigged court of inquiry §11.p3

    Parallel case to Kaydon, invoked at the lecture's close to generalize the "rigged board of inquiry" pattern. The court was instructed to find a fixable cause to protect the $40 billion program from Congressional cancellation. Tom served as expert witness in the subsequent civil suit by widows; his hydraulic-leak-in-the-upper-nacelle theory (one miracle) displaced the Navy's nacelle-fire theory (six miracles); the JAG investigation eventually adopted Tom's theory.

  • NASA Langley supersonic helicopter blade-tip experiment §2.p3

    Cited to explain why conventional helicopters are speed-limited around 200 mph — once the advancing blade tip approaches Mach 1, vibrations and instabilities will rip the blades off. NASA built and flew an experimental helicopter with a jet engine on the back to break the barrier deliberately; it's now an outdoor exhibit at the NASA Hampton facility.

  • V-22 Osprey (general) §2.p4

    Cited in passing as the tilt-rotor solution to the Mach-1 blade-tip limit — tilts to airplane mode for 300 mph forward flight. Distinct from the Ship Four crash case treated in §11.

  • Large ship forgings supplier dispute (unnamed) §11.p3

    Mentioned in one sentence as an analogue to Kaydon — Tom got the chance "about 20 years later, to screw that company that screwed the other company, just by chance." No further detail given here; presumably developed in another lecture.

  • MIT engineering curriculum history §12.p2

  • MIT School of Engineering retreat (mid-1980s) §11.p6

Layer 2 — cleanup edit
p1 00:01

Questions? We were talking about making measurements and the precision of parts per thousand, yesterday, parts per million, that you can measure mass length and time. We can measure more precisely anything else.

p2 00:20

But I'm going to start today by telling you, well I guess you'd call it a case study if you're at Harvard Business School, which is going to talk about a product that has some very precise manufacturing tolerances and what you have to do to achieve some of those, what happened when the company screwed up, why they likely screwed up, and how someone else blamed the next failure that occurred, which killed a couple of people, on that same cause, even though it wasn't the same cause. And how after the fact you can make a measurement of something that's completely destroyed, or virtually completely destroyed, you can still get some idea in that particular case of whether it really had the manufacturing dimensional defect or not.

p3 01:18

And it has to do with the helicopter swashblade [swashplate]. This is a helicopter swatch plate [swashplate] — did anybody know what a helicopter swatch plate does, or is? Exactly. Every helicopter — and in fact here's Igor Sikorsky in 1939 flying his first working helicopter — and up here there's a mechanism. Obviously you don't want the passenger compartment to rotate, you want the blades to rotate, so you have to have a stationary plate and a rotating plate that come together and it's called a swashplate, okay.

p4 01:57

So when I was rotating, it's got, in the old days it basically was just sort of a spherical dish that was stationary and another spherical dish, and you just grease the whole thing up. And so you had, you know, two saucers, one rotating inside the other with a bunch of grease. Well now we use bearings rather than the early ones. But what happens is, if you think of the plate, a plate can be rotated in x or y direction, and that can give you control for two things on the rotor blades.

p5 02:30

And one of the things that you want to do on the rotor blade — you want to take that disc, rotating disc, and you want to change the angle of attack of each one of the blades as it's going around. You want to tilt the blade up to a higher angle if you want to go up, you want to tilt it down if you want to lose height, you keep it at some intermediate level to maintain height. And then you also want to go right or left. And the first one is called collective, okay. You collectively move all the blades with the same angular rotation to give you more lift up or less lift down.

p6 03:09

Faster — nope, they in fact, you want them to, well I'll talk about that in a second, I'll answer that in just a second. The other one is called cyclic, okay. And the pilot in the helicopter has a lever for the right hand and a lever for the left hand. If I remember, the left hand is the collective that allows you to go up or down, and the cyclic allows you to tilt that rotor disc. If you want to go forward it tilts it going forward, if you want to go this way it tilts it that way, to go right that way, to go left, if you want to go backwards you tilt it back.

p7 03:43

So one is the cyclic, is the angular orientation of the rotor disc, and the collective is the actual angle of attack of each individual blade. And they are collectively — you can have up to seven, well actually there's a Soviet helicopter that has eight blades — so all the blades would get the same angle in collective. That's one way to think about it. So the pilot is controlling the main rotor with his two levers, collective and cyclic, and then his two feet are controlling the rear. You have a, well this is a NOTAR [no-tail-rotor].

p8 04:26

Anyway, I'll tell you what a NOTAR is, but even with — they had a little blade back here, um, unless you've got two sets, well this one has a second blade, and that's to counteract the fact you've got friction in the system and the thing is going to start to spin if you don't have some restoring force to keep it heading in the same direction. And in fact if you lose that tail rotor the thing will start spinning out of control and crash, okay.

p9 04:57

Now this is what's called a NOTAR, no tail rotor, and they actually have a little fan — great big fan actually, well it's about this big — a fan here that blows air out the side, I'm sorry it blows air out the side, to be the counteracting force to keep the thing from rotating. So it simplifies the mechanics. This tail rotor, this tail boom, is just a tube, whereas this tail boom it's got bearings and shafts and all kinds of things that can fail, okay.

p10 05:35

In any case, so did I answer your question about that or — wait a second, no, what was your question? Oh they didn't change the speed. No, the speed of the helicopter is limited by the speed of the advancing blade. Now some blades are clockwise from the top, some are counterclockwise depending on the designer, you can design them both ways. But the limiting speed is when this hits Mach velocity, Mach 1. You can't go any faster, okay, because you have to break the sound barrier. And so at that point you start getting all kinds of instabilities and vibrations, and typically you'll rip your blades apart because of the vibrations and stuff.

p11 06:23

If you go to, is it NASA — it's not NASA Langley, anyway, down in Hampton, Virginia, there's a NASA facility where they do test flights and stuff. They have a helicopter out there. NASA once flew a helicopter that had more than Mach 1 blades. But typical helicopters might be limited to 200 miles an hour, and they can't go 250 miles an hour because you'll rip off the blades from the vibrations of trying to break the sound barrier. You get a sonic boom and you get all kinds of vibrations and things that you don't want.

p12 07:06

And that's why the V-22 Osprey, the Marines' sixty million dollar helicopter, tilt-rotor helicopter, it can go 300 miles an hour because it can tilt. So the rotor blades are now in airplane mode, okay, and now you don't have the additional velocity in the air of your forward motion, you just have the tip speed. Okay, the receding blade is always going less. You know, one blade is going plus your forward motion, the other is getting around to the nine o'clock position it's plus your forward motion, at the three o'clock it's minus your forward motion. No problem with the receding blade, it's the advancing blade that you have to worry about that will set up instabilities and vibrations that'll crash.

p13 07:52

But NASA once did it with a big jet engine off the back of this experimental helicopter. If you go down there, it's sitting out in the lawn in front of the administration building and you can go up and look at this thing. Because it does — I mean it was unsafe to fly, okay. They did it because someone wanted to see exactly what happens when you start breaking the sound barrier with your blades, plus you've got all the noise of breaking the sound — it's pretty noisy, and helicopters are noisy enough.

p14 08:29

But anyway, so I don't want to get into all the physics of helicopters. But what happened was, in this particular case, the Japanese Maritime Defense Forces, which means the Japanese Navy — they're not, by their constitution, the Japanese are not allowed to wage an offensive war anymore. We wrote the constitution for them in 1945. And, well, this is a big deal for the Japanese because they're very proud of the fact that they only have defense forces, they don't have offense forces, okay. And so their military is called the Defense Forces.

p15 09:07

So anyway, one of the Japanese Navy helicopters crashed in the Sea of Japan, about five or ten thousand feet of water. Took a long time to get it up, but basically it was out there and the swashplate just seized up, the bearings seized up. Yeah, it was down in the ocean for so long that by the time they got it up it was so corroded they couldn't quite tell. And it was the first time anything like this had happened, even though this type of helicopter was first designed like 1964 or '71 or something. And they hadn't had failures until this one in the late '80s.

p16 09:47

And so they didn't, and plus it was Japanese people, so who cares. I mean, I'm not saying that — I'm just kind of, there is sort of, within the U.S. defense community, it's kind of, well, but if it was a U.S. soldier that died you see this even in Afghanistan, right. I mean, it's a big deal if an American soldier gets killed by a terrorist, it's not as big a deal if an Afghani gets killed by a terrorist, right. I mean it's just the way it is. I guess I am commenting politically, but I was commenting racially, okay.

p17 10:19

Anyway, so here's the swatch plate. It's a very complex assembly. You have these — this is one of the linkages, there's another linkage, I don't know if I can see the other linkage, but this is one of the linkages. When the swatch plate tilts — this is either collective or cyclic, I could probably figure it out — in any case, there's a bearing inside here. So the bearing failed, and it failed on an aircraft that was on its initial two-hour [flight]. It had just been built, it hadn't been turned over, there was no DD-251 or something form, which is actually a standard form that transfers ownership from the contractor to the government. So a one-page form, and so you have to have a point in time of who owns that helicopter, okay.

p18 11:13

And one of the performance specifications was every helicopter has to fly in a hover for two hours before you can sell it to the government. So they had these two test pilots and they were just doing their two-hour hover above the field, okay. They weren't going anywhere, just hovering for a couple hours. Then crashes, the guys are dead, okay. And they look at it afterward — the swashplate bearing seized up.

p19 11:41

So politically — and a lot of the story has to do with the politics of this and not necessarily the measurements of the mechanics — politically the Navy said, "This was going to be a Navy helicopter. Since we haven't gotten the transfer of ownership, this really belongs to you, helicopter manufacturer, and therefore you can do your own board of inquiry." Ordinarily when you have any crash of any military aircraft — I mean this is a forty million dollar helicopter — there's a board of inquiry, you know, why did we just lose forty million dollars worth of taxpayer equipment? The Navy said, "We didn't lose a thing, we didn't own it, you owned the loss, okay. It didn't match it back before you sold it to us."

p20 12:27

Well it turns out, so the helicopter company forms their own board of inquiry. They did not allow — even though everybody knew it was a bearing failure — they would not allow the bearing company to participate. Ordinarily when you have a failure like this of any aircraft, even civilian aircraft, in civilian aircraft the National Transportation Safety Board goes out there and they form a team of the owners of the aircraft, which could be Delta or U.S. Air, um, the manufacturer could be Boeing or Airbus, if it's the engine they might have Pratt Whitney or General Electric. They bring in a team of people who are experts, who manufacture the different components, and they'll all get together to try to figure out what happened, why did this thing crash.

p21 13:16

Well in this case, they knew it was a bearing failure, but they wouldn't let the bearing manufacturer participate, and they didn't have to because you didn't have the Navy chairing the board of inquiry. Who did you have heading up the board of inquiry? Well they did have a helicopter company engineer, but the guy who was really running it, they put the lawyer for the helicopter company on the board of inquiry. And so whenever they had — and they had to have public meetings where they had a court reporter transcribing what they were talking about — whenever they got to anything interesting in this like three-week investigation, the lawyer would say, "We should go off the record."

p22 13:58

So anything of any interest because of the failure was off the record and there's no transcript, okay, because there was no one watching the hen house and the fox was in the hen house. They had the attorney on the board, okay. Sounds rigged. It is, okay. Just letting you know how things work.

p23 14:22

The bearing is — a bearing looks like this, it's actually called a really slim bearing. Actually I have a better picture of it. Was not an Apache helicopter — that's an Apache helicopter right there. But a Reali-Slim bearing is made by Kaydon and called Reali-Slim. And these things go in not only helicopters, they go in CAT scan machines, okay, at hospitals. It's a bearing that — this particular one was 40 inches in diameter and it had a one-inch cross section with half-inch balls. So if you looked at the cross section of the whole thing, this was one inch by one inch. There's the outer race, the inner race, and the ball was a half-inch ball, okay.

p24 15:18

They've made thousands of these for lots — and this was the largest one that anyone in the world made, in fact, they were a sole source. There's a company in Germany that makes something like this, but not exactly like this. Well, the prior history, yes, they had a failure of the swatch plate on a Japanese helicopter. This was the second failure they had ever had, and they've been producing this helicopter for twenty-five, thirty years at this point, okay. So this is sort of a new type of failure, and they didn't even know it was related to the Japanese failure until they started their board of inquiry. And they said, "Oh, we had one of these helicopters go down in Japan, let's go over to Japan." They flew over to Japan, saw the pieces, and they said, "Oh, that was a bearing failure too."

p25 16:04

And they started looking. At one time the company had manufactured six bearings — now I can't remember, these bearings went for forty thousand dollars apiece, or a hundred thousand dollars apiece, they weren't cheap bearings — and they had manufactured six of them and one of them started creating some vibration. And they took it off and looked at it and it had what's called a closed conformity.

p26 16:32

What's a closed conformity? Well, this is just a generic bearing. This is an open conformity. You want the balls to roll and ride at the bottom of the groove. You see the ball — the rounded groove has a larger radius than the ball, right. A closed conformity, which I have — I couldn't find one anywhere because no one ever makes these intentionally, okay — a closed conformity is one where the ball has a larger radius than the curvature of the groove and it's riding on the edges, not a good idea, okay. A lot of sharp contacts, stresses, and you wear out those edges. That's what caused the vibration.

p27 17:17

Well it turns out one of the six bearings that had been manufactured had a closed conformity. Someone found it, someone in the military found it, they wrote it up, and there's all kinds of documentation. The Navy was all concerned and they went and started inspecting other things, but they decided it was just a one-of-a-kind. Well why was there a closed conformity? Well, it turns out when you've got something as flexible as a 40-inch diameter ring that's, you know, a couple of small rings that are only one inch high and even less in thickness, that's pretty flexible. You pick one of these things up — you actually can torque that piece of steel. If you just had the outer ring or the inner ring, you can actually turn it into a potato chip shape with your own wrist, okay, when it's that long, right.

p28 18:10

So it turns out, that bearing is pressed into an aluminum housing which is the swatch plate, it's the upper swatch plate, okay. And that aluminum housing is milled on a vertical boring mill, okay. But the thing that gives the shape to the bearing is the swashplate aluminum housing. Well, turns out the helicopter manufacturer, who manufactured that big aluminum housing themselves, they just never bothered to look into the shape of that housing, and in fact they destroyed it. And not only that, about six months after this whole inquiry started they destroyed the three-year-old milling machine that had made it. There was no way to go back and prove what happened to this aluminum housing.

p29 19:01

And the tolerances we're talking about on these things — the diameter of that bearing, 40-inch diameter bearing, is supposed to be 40 inches plus or minus 2 thousandths. That's one part — if it's four thousandths total variation, plus or minus two, right, out of forty inches, that's one part in ten thousand. And what did I tell you yesterday? A typical manufacturing tolerance is one part in two thousand for machining or measuring something. If you've ever worked in a machine shop and you're trying to turn on a lathe the diameter of something to one inch, it's hard to hold anything better than half a thousandth. You can grind it and lap it and get down to a tenth of a thousandth, but if you're doing that you now have to start specifying the temperature at which you made that measurement, okay. And the tools that you're making the measurement with, which also are steel, have to be at the same temperature.

p30 20:18

And so when they grind this bearing at Kaydon, the whole thing's in an automatic grinding machine. You set it up and jig it and now you're going to have the grinder go around and grind the grooves on the diameter and make sure everything's as spherical as possible. Well that's sort of inherent in the way the vertical boring machine works. But they actually take the micrometer — and the whole thing is just flooded with oil while the machine's running, I mean, coolant, right, as lubricant and coolant, for the whole thing to keep it uniform temperature — they put the micrometer right there on the bed of the vertical boring mill and it's bathed in the same bath of oil. So that when they measure it they're measuring it with the tool at exactly the same temperature, right. Who cares if it's 66 degrees or 72 degrees, as long as the two tools are calibrated and they're at the same temperature you should get a valid reading, okay. So that was one of the ways, because they're trying to hold one part in ten thousand, which means you've got to be within about two degrees Fahrenheit of the same temperature, or you'll be off by that one part in ten thousand, okay, something like that.

p31 21:35

So that wasn't how they caused the closed conformity. What happens is, those balls are not just half-inch balls, they're 0.500 — they were half inch to 50 millionths of an inch, okay. Because they've got to run true in this 40-inch bearing, and actually as you get larger and larger diameter, the need to run true and to have the tolerances actually gets greater and greater even though you're getting larger. If you think about it, you're heading in the wrong direction, which is one of the limitations on the ability to even manufacture bearings this thin and this small.

p32 22:17

So it's supposed to be a ball diameter of, uh, okay, or whatever, but it's got to be — well actually I could write it this way. Actually I think it was 25, I think the total was 50 thousandths [millionths], so it's plus or minus 25, but anyway. You start looking at that — well now this is tighter than one part in ten thousand. So this is one part in twenty thousand.

p33 23:00

So how do you do it? You can't, even by lapping — manufacturer, if you put a bunch of balls on the lapping table, they will not come out with that type of tolerance. And you had to have 192 balls, okay, that had that tolerance. 192 is the number around this 40-inch circle. So how do you do it? There are many cases in manufacturing where your tolerance required is tighter than anything you can manufacture the individual part to. So what they do is they make matched parts. You make a bunch of parts, and then you pick this one and measure it, you pick that one and measure it, and you put the two of them together in matched sets.

p34 23:51

They make 50,000 balls, half-inch balls, and then they sort them into which ones are fifty thousandths [millionths] exactly — are half an inch exactly — which ones are fifty thousandths [millionths] under, which ones are twenty-five thousandths [millionths] under, which ones are fifty thousandths [millionths] over, and they group them, okay. And they group them into sets.

p35 24:15

Well if you went into Kaydon's shop, or you go into a Pratt Whitney shop — the two places I've been, I've seen these things, they have micrometers that are accurate to this. The micrometer looks like a lathe to measure a half-inch ball. It's sitting on the floor, it's the size of a small lathe. The room is temperature and humidity controlled within one or two degrees, okay. And there's a person sitting there putting the ball, this little half-inch ball, in the micrometer of this great big machine that's got all these compensation things to be able to measure something that small and do it reproducibly. And so you've got someone sitting there making minimum wage measuring each ball, putting them in different bins. And here's a set of 192 — or they might actually make it a set of 200 in case someone lost one, right — that will go into the assembly room where they have the two rings that have been ground as a matched set to about four thousandths plus you know, to about four thousandths, and then they put the balls in based on a more precise measurement of the actual grooves and the shape of that groove, okay. Because, yeah, if I only had to do it to a tenth of a thousandth, no big deal, but when I have to do it to a half a tenth of a thousandth, I actually have to use matched sets of balls.

p36 25:47

So how did this closed conformity out of six bearings ever occur? Well, someone probably picked up or mislabeled a set of balls and assembled them in there. Now there were other inspectors who should have caught it before it went out, but they didn't, and it got out, started vibrating on a helicopter, and they caught it, no one got hurt.

p37 26:13

But the inspectors for the government — because you have, we're going to talk later about inspectors — you have each individual employee is supposed to be their own inspector with a little "i", and then the company has their own inspectors with another little "i", and then the Navy has someone full-time in that plant and they're the capital "I" inspectors. But they don't really do the inspecting, they're just checking on the quality control, they're doing quality assurance, they're not checking every part, okay.

p38 26:44

Until this one went down at the helicopter company, killed two test pilots. And now the helicopter company says, "Oh, we have one like this in Japan." And the Navy down at Cherry Point has a pilot with one of these helicopters coming in for a landing, and as he's about to land he's about two feet off the ground, his swashplate seizes and he slams two feet down to the ground. Well nothing happened, but it was a seizure. They take it apart and they say, "We had a bearing failure." And all of a sudden within the next few months they had four or five bearing failures, and they grounded the whole fleet.

p39 27:26

And if you want to see an admiral or a general in the military really upset, ground the whole system for the entire world, okay, because now that part of your whole defense scheme is not operational. I mean, I had a situation once where an aircraft carrier got pulled back into port because of some bad welds they just made on the steam system. And this was right as they were starting the invasion of Grenada — we invaded Grenada like 20 years ago, or 30 years ago, 25 years ago. And they had waited for that aircraft carrier to get out of Philadelphia Naval Yard before they started the invasion, because at that point they were going to use the other aircraft carrier in the Atlantic Ocean for the invasion of Grenada, and they had to have one to protect against the Soviet preemptive attack, okay.

p40 28:27

Well when this — they start the invasion — the one aircraft carrier gets out of Philadelphia Navy Yard, president says okay, go invade Grenada, and they start the invasion which took like a week, okay. But in the middle of this invasion a couple days later, they find they have steam leaks in the engine compartment of the aircraft carrier that's defending the entire North Atlantic, okay. And they have to go into Jacksonville Naval Air Station — they Naval Shipyard — for emergency repairs. And all of a sudden we have no aircraft carrier defending the North Atlantic, and if the Soviets wanted to attack, that's the time to do it, right.

p41 29:09

Well, people get really upset. I talked to some of the guys in the Navy who were charged with going down to Jacksonville and fixing this. They were getting phone calls at 2 a.m. at home and saying, "A helicopter will land on your lawn at 3 o'clock, be on it." And they were being ferried from their home to Jacksonville, Florida, to start working on fixing this aircraft carrier. When the military needs to move, they can, okay. Now that's a true story, okay.

p42 29:39

So this whole fleet of, I'll just call it heavy lift helicopters, was grounded, and the admirals are going berserk. So what do they do? And the helicopter company, who knows it's a bearing failure and they don't want it to be their bearing failure, they tell the government, "Oh, Kaydon did a terrible thing, they made a closed conformity, this must have been another closed conformity bearing." Well, how many times is someone going to pick up the wrong bag of balls? That was sort of a one-of-a-kind type of thing. But the government doesn't know necessarily.

p43 30:18

So all of a sudden the FBI gets called in. Criminal investigation, okay. Every bearing at Kaydon of these types of bearings was impounded, and they invoked the Emergency Powers Act, which says that the government, the military, can come in and take over your manufacturing facility in a national emergency and put everything on number one priority to fix the problem. And all of your other commercial orders and everything take a back seat. If you have time to manufacture something else, that's fine, but we're going to have FBI agents and government inspectors next to every one of your manufacturing employees making sure that the government parts get out the door first. That's the law. It's because of national security.

p44 31:08

So the government took over the Kaydon plant, Muskegon, Michigan, okay, and started making new bearings absolutely perfect to spec, okay. I mean, you had all the Kaydon inspectors, you had the government inspectors, these things got inspected fifty times more than any regular bearing, and they were certified by both Kaydon and the U.S. government that they met every single standard and specification they were required to make, and the FBI was there to make sure that they were ready to put handcuffs on anybody who didn't cooperate, okay.

p45 31:45

They put some of these new ones in the field, and these bearings were better bearings — none of these manufacturing defects — and they put them into the helicopters. And those new helicopters that have these new bearings — and they had to manufacture a thousand of these, okay, so that's four million dollars or forty million or something, anyway whatever it is, it was expensive, but it's also done in a rush — all these things go out there, and guess what? Within two months one of them fails. One of the good bearings fails. But it was perfectly within spec, and these things have been flying for 30 years. What had happened?

p46 32:36

Well, I was brought in not as part of the criminal investigation, but at this point the helicopter manufacturer decided, "Well, we had to pay for — we lost a 30 or 40 million dollar helicopter, we're going to sue Kaydon." I mean, the dead pilots are going to sue Kaydon in criminal court, okay. And the FBI has impounded all the evidence. And we're going to sue Kaydon in civil court for the loss of the helicopter because the Navy didn't buy it, we still owned it, we lost all this money.

p47 33:09

Well it turns out Kaydon settled the criminal case very quickly because criminal cases are not things you want to defend yourself when the government's going after you. In a criminal case they sort of have the upper hand. So they settled that one for about 15 million dollars with the families of the two pilots. But I was there to figure out, did this thing have a closed conformity?

p48 33:31

Well, when it seized, it seized because it was generating too much heat, and that aluminum housing — aluminum will absorb a lot of heat — and when it crashed and landed, the heat started to soak back into the steel bearing. I mean, the aluminum housing's 20 times the mass or 50 times the mass of the steel, and it soaked back and it just impressed the balls against the races of the bearings. And everything was overheated, deformed, and we're supposed to go in there and figure out whether these things are accurate to 50 millionths of an inch. Well, that's pretty much impossible, right.

p49 34:22

And that's what the helicopter manufacturer was depending on, that no one could figure out what had happened and whether this was a closed conformity. They're going to use the history that had once been a closed conformity a couple of years before that never caused a big accident, to say, "Oh, they did it again, shame on them. You know, pay the pilots 15 million, we want another 15 or 20 or 30 million, okay, for our destroyed helicopter. And FBI, oh it's terrible what this bearing manufacturer has done to us and to the government, okay, you should consider further criminal action, okay."

p50 35:01

Well, what are you doing, helicopter company? They're the sole source. If they quit manufacturing these bearings for you — if basically the FBI leaves and says no longer a national emergency — they say, "We don't want to do business with you." Can't ever make another helicopter, because there's no one else in the world who knows how to make these bearings. So this is sort of a problem when the attorneys in the company start running the business, okay. They don't worry about the long-term consequences of not working with your suppliers. They just want to show that for their annual bonus that they collected a lot of money for you.

p51 35:40

Well the question was, it closed conformity? Well, we went out to Muskegon, Michigan, for several days, and there were a couple of bearing experts with me, I was the metallurgist. And it turns out we couldn't look at it without an FBI agent in the room with us. We couldn't touch a thing unless he was there, okay, because they were still considering criminal action, okay.

p52 36:11

But we looked at it for two days, you know, trying to see whatever the patterns were. Finally at the end of the second day I looked at it, and I kind of, you know, sort of used "looking at the forest for the trees" — I said, "There's no closed conformity." I had 188 measurements that proved there was no closed conformity on this bearing.

p53 36:34

And the way I did it was, if you think about how a bearing ball sits in the races, it actually forms a little elliptical — I've got it upside down, not that it really matters — it forms a little elliptical contact surface, which when you embed the ball — it's called brinelling, when you embed the ball in the race — it forms an elliptical wear mark, an impression, okay. It's just a hardness test. If it had been a closed conformity, what would you have had? Actually an hourglass. The railroad tracks would be on the edges, and we had been looking at those edges for a day and a half, to try to say, well, but it was so beat up and been through it — some parts of it got to eight, nine hundred degrees centigrade, okay, transformed, okay.

p54 37:32

So we had been looking at the races, trying to figure out whether it's closed conformity, was it contacting in the bottom or on the edge. I started looking at the wear marks in the bottom. If it's an open conformity, you get an ellipse. If it's a closed conformity you get an hourglass, because it's contacting here. And when the ball embeds into the piece you form an hourglass. We didn't. We had four of them you couldn't even tell, but of 192, 188 you could see a nice little ellipse. There's no hourglass there.

p55 38:04

And from the shape of that ellipse we probably could have calculated exactly what the conformity was. So I was all excited, okay, we're going to take that helicopter company, we're going to stick this down their throat. And so that night the attorney, or the law firm that hired me, their big-shot name on the letterhead attorney came in, and the brand-new president of Kaydon came in, and we all went down to dinner on the waterfront of Lake Michigan, and there were about 20 people there between all the experts and the attorneys and everybody.

p56 38:43

And I'd explained to what I call the outhouse attorney — they have in-house attorneys who work for the company and outhouse attorneys who are private attorneys — I was explaining to him that day, and I had showed him how we could prove this was not a closed conformity. There's no doubt, I had 188 witness marks and they all said 100% that this is open conformity. And I figured he would explain this to the in-house attorney for Kaydon and the new CEO of Kaydon, and they talked about the criminal case and everything, and they were having their attorney dinner conversation.

p57 39:25

And what happened is, Kaydon settled the case with the helicopter manufacturer for another 15 million. And the reason is — now this is an important lesson here — the new CEO, this problem had not occurred on his watch, and he was going to get rid of it at the beginning of his new watch. And he didn't care what it cost to get rid of it, he didn't care whether he was right or wrong, he just wanted to get rid of it. So he bought his way out, because he could blame it on the previous CEO, right.

p58 40:00

So I spent three days in Muskegon, Michigan, for nothing to figure out what happened. But in fact we did know what happened. And it was sort of the thing we were looking for — little wear marks along the edge. We were looking, could we measure anything? This thing had been cut up into little pieces by the helicopter company, okay, it was no longer circular.

p59 40:22

But then of course we said, well why did it fail? We looked at those wear marks, and you could break the wear marks into four quadrants. Two of the quadrants you had deep elliptical impressions, and two of the quadrants that were opposite each other had shallower witness marks. And one of the other bearing engineers says, "Swatch plate had to be potato chipped." If you put a perfectly spherical bearing into a swashplate that has a potato chip shape, and you now start thinking about what you have — that potato chip ends up creating a minor axis and a major axis, right. It's effectively a little ellipse, and it's going to get deep impressions on the minor axis and smaller impressions on the major axis.

p60 41:23

So that's when we started looking into, well, where are the other swatch plates that were machined just before and just after this? Because in an aerospace fabrication operation they can tell you by serial numbers exactly which part was made on what day and everything else, so we knew all the brothers and sisters of this swashplate. But mysteriously they had all seemed to have evaporated. The helicopter company had gone out over the previous two years and for various reasons they had determined that these swashplates needed to be replaced, kind of on a one-by-one basis, until they were all gone. They didn't exist. And we said, "Well, where are they?" "Were government equipment." Well, they'd taken them back and they had scrapped them.

p61 42:17

And we said, "Well, we want to see the milling machine that produced these swash plates." "Oh, that was three years old, it was too old, we scrapped it three weeks [ago]." Yeah, three-year-old milling machine, you know, a quarter-million-dollar milling machine, three years old, they scrapped it. So you don't think the helicopter company knows what happened? Okay, they knew exactly what happened. They had a milling machine that was out of spec, machined a potato-chipped swashplate. The bearings — these Reali-Slim bearings — took the shape of the swashplate. They did their own investigation. The fox was watching the hen house, okay.

p62 43:03

Now there should have been a criminal investigation, but not of Kaydon, of the helicopter manufacturer. And that's why I haven't told you the name of the helicopter manufacturer, okay. Did you tell the FBI about that? We didn't tell the FBI. It's not for me to start telling the attorneys how to manage the whole thing, okay. But in fact, if someone wanted to — but remember, the guy who's going to decide this at Kaydon, he wants to get rid of it. He wants it off his watch. The last thing he wants is to have a continuing investigation.

p63 43:43

But just as another point of fact, the military is not as stupid as the helicopter manufacturer. The helicopter manufacturer is willing to throw their monopoly bearing manufacturer under the bus. The U.S. Navy is not going to throw their monopoly helicopter manufacturer under the bus, okay. They could run an investigation and they would probably find, "Oh, the evidence is not available." Well who made the evidence not available? Duh, okay.

p64 44:16

So this little story, which took longer than I had expected, has a number of little parts about precision measurement, but mostly it's one about how the system works, okay. And how we do have standards. Ordinarily, if this had been a military helicopter, there would have been some Navy captain or Army major or Marine major or somebody in charge of the investigation, and they would have found the problem because they would have invited the bearing manufacturer to participate in the investigation. Someone would have said, "Oh, what about the swatch plate?" Whenever those things came up — and they probably did come up at the meetings of the board of inquiry of the helicopter manufacturer, but that was when they went off the record, okay.

p65 45:09

And we could read those transcripts and we could see, well, someone might say, "Well, we ought to look into this swash plate," and then they go off the record, and we wouldn't get to hear what they had to say. But in a regular investigation, when you don't have people trying to cover something up, you know, it would have been run properly and maybe justice would have been done.

p66 45:34

Look, I could tell you half a dozen stories in different industries — one, big forgings for ships, where a company got screwed by another company. Now I did have the opportunity, about 20 years later, to screw that company that screwed the other company, just by chance. I could tell you on the V-22 Osprey, okay, how that court of inquiry was rigged, okay. They were told they had to find something that could be easily fixed — and this may be on one of the other videotapes, so I apologize. The Marine lieutenant colonel, anyway, or maybe a Navy captain, anyway, the guy who headed up the board of inquiry for the V-22 Osprey Ship Four crash told someone in a bar one night that they were told they had to find something that could be easily fixed so Congress wouldn't scrap the 40 billion dollar program, okay. So that one was rigged, okay.

p67 46:43

And they came up with a fault, they blamed it on the helicopter company, got sued by six widows, okay. And turns out they settled with the two military widows very quickly. They offered settlement to all the other four widows right before the trial, offered them two million dollars apiece, and two of the widows said, "Okay, we'll take it." The other two widows were advised by their attorneys that, "No, we'll get you 40 million dollars." And they lost. In fact the four women of the jury in Philadelphia said that I was the one who convinced them that it was not a fire in the nacelle, it was a hydraulic leak in the upper nacelle.

p68 47:31

But in any case, afterwards the Judge Advocate General of the Navy came in, looked at the court testimony, did another investigation after the court of inquiry that included Boeing and Bell and a couple of other companies. They revised the report and adopted the theory that I had, okay. Because it turns out — I always say the Navy's original theory required six miracles in sequence for the crash to occur. My theory only required one miracle, okay.

p69 48:11

Which is, I guess the point of that is, you never have all the pieces, okay. You have to figure out what pattern explains the most pieces of your puzzle. I mean that's part of what engineering is. In fact, in the mid-'80s I went to a retreat down on the Cape with the School of Engineering, and they tried to define at this retreat, what is engineering. And they did come up with the definition, which is probably still in the records over there. But an engineer is someone — part of this mission statement, mission statements and things were big back then, but it wasn't a mission statement — an engineer deals with complexity and ambiguity and solving problems, okay.

p70 49:03

So you rarely have a set of facts where everything just fits in perfectly, and if you do, then you don't need people to be fighting over it because it's obvious, right. If all the facts fit, then anyone can look at it. Most of the time you're dealing with a number of conflicts, and you have to figure out which one makes the most scientific sense, okay. And so that's part of what an engineer does.

p71 49:35

And I guess I have a couple minutes, so I can give you my story, I don't know if you've ever heard it before, it may be on another tape, I give this story all the time, of the history of the term engineering. Anybody know what the word engineer comes from? Engineering in this country only goes back a couple hundred years. The word engineer comes from the French, if you look in the Oxford English Dictionary, you'll see this comes from the French ingénieur, which begins with an "i", which, as Professor Sataway [Saadeh?] say, comes from ingenuity, the Latin root for ingenuity. But an engineer before 1800 was basically a maker of war machines.

p72 50:21

The first engineering school in this country was West Point, 1797 or '92, 1790-something, and they trained military engineers. In 1823, the second engineering school in this country was Rensselaer Polytechnic Institute, in Troy, New York. And they were creating engineers to help build what was the big construction project in New York in 1823 — the Erie Canal. And they needed people to dig the canal and build bridges and dams and locks and things like this. And so they created a curriculum of engineering different from the military engineers who built breastworks and catapults and things like that. And they called it civil engineering to distinguish it from the only type of engineering that existed before that, which was military engineering.

p73 51:14

And then there were other schools — like Michigan claims to have engineering in the 1840s, but I don't know how many bears in Michigan in 1840 were going to university and studying engineering. But in any case in 1860s, MIT actually started to differentiate, and what's Course 1 at MIT? Civil engineering, because that was the only type of engineering in addition to military engineering. MIT decided to break it up into other disciplines. One of those is mechanical, that's number two. And number three is mining — not mining and metallurgy, didn't enter until 1888, okay, it was mining engineering. Coal mines, copper mines. And four was actually architecture. Five I think was chemistry. Six, I don't know what the original six was. Eventually electrical engineering didn't start until the 1880s, after Edison and Westinghouse gave us a ready source of electrons, okay.

p74 52:18

But MIT also defined the field of chemical engineering back in the 1880s, nuclear engineering in the late 1940s — we were the first. Um, anyway, a number of the fields of engineering — aerospace engineering, we had the first aero and astro, or aero, aeronautics department, there's no astro department originally, okay. But Hunsaker, in like 1917, started an aeronautical department. So MIT has actually defined a number of the fields of engineering. Not all of them — we didn't define electrical. But anyway, okay, I'll see you Monday.