US2196909A - Apparatus for recording respiratory and circulatory conditions - Google Patents

Description

A 9, 1940. T. BRADFORD APPARATUS FOR RECORDING RESPIRATORY AND CIRCULATORY CONDITIONS Filed Dec. 31, 1936 5 Sheets-Sheet 1 April 9, 1940. 'r. BRADFORD APPARATUS FOR RECORDING RESPIRATORY AND CIRCULATORY CONDITIONS 5 Sheets-Sheet 2 Filed DeG. 31. 1936 April 9, 1940. 1'. BRADFORD APPARATUS FOR RECORDING RESPIRATORY AND CIiiCULATORY CONDITIONS Filed Dec. 31, 1936 5 Sheets-Sheet 3 I azzforr' April 1940- T. BRADFORD 2,196,909

APPARATUS FOR nsconmne RESPIRATORY AND cmcuwrom CONDITIONS Filed Dec. 31, 1936 5 Sheets-Sheet 4 April 1940- T. BRADFORD 6,909

AIPARA'I'US FOR "RECORDING RESPIRATORY AND .CIRCULATORY CONDITIONS Filed Dec. 31, 1936 5 Sheets-Sheet 5 Patented Apr. 9, 1940 APPARATUS FOR RECORDING RESPIRA- TORY AND CIBCULATORY CONDITIONS Thomas Bradford, Chicago, Ill., assignor to William 1. Cameron, Chicago, Ill.

- Application December 31, 1936, Serial No. 118,565

'1 Claims.

My present invention relates to an apparatus for indicating and recording conditions occurring in both the respiratory and the circulatory system of the human body. With the present apparatus the attendant or operator may readily determine the systolic and diastolic pressures of a person under examination, the rhythm of the heart beat and the characteristics of the pulsations. Furthermore, the operator may ascertain the rhythm of inhalation and exhalation and the characteristics thereof. Also the attendant, during the ascertaining of the aforesaid conditions may definitely record them upon a single chart or graph-sheet in order that these conditions may be studied for the purpose of diagnosis and the chart thereafter kept as a permanent record of the particular patient. In ascertaining conditions of both the circulatory system and the respiratory system visual means are provided,

go preferably in the form of an illuminated lamp or target in order that the operator need not depend upon the use of a stethoscope.

Abnormal conditions occurring in the respiratory system of a patient frequently influence the 25 determination of conditions in the circulatory system, and it sometimes transpires that while blood pressures and heart beats of a particular patient are being recorded the patient may either inadvertently or intentionally, retard or 30 increase his respiratory actions. When these conditions are present there is a consequent abnormal change in the circulatory system. For

example: if a patient, during the transcribing of a record of his heart beats or pulse should inten- 5 tionally hold his breath there is an immediate retardation of the rhythm and the characteristics of the heart beats. With the present apparatus I have arranged the structure so that the record or graph made in recording the blood 40 pressures and heart beats is alongside and parallel with the recorded graph of the respiratory system so that it is definitely co-ordinated therewith to such an extent that the physician making the record or the examination will be able to 45 immediately determine whether the abnormality noted in the circulatory graph has been caused by an abnormality occurring in the respiratory system during the recording of the heart graph.

It will be apparent this is of vital importance in 50 securing an accurate record of a patients heart and circulatory conditions. Provision is made in the present apparatus for charting auricular conditions through the medium of the jugular at the patients neck. This permits the physician 55 to note auricular abnormalities which may not (Cl. lea-2.05)

appear on other portions of the chart or graphsheet because of the fact that the record of the diastolic pressure is subject to influence by the contraction of the left ventricle of the heart.

The apparatus which I have devised is en- 6 closed within a small cabinet so that it is readily portable and may be carried from one-location to another by the physician. The present structure is therefore considerably less cumbersome than the large devices and apparatus which are 10 usually installed in examination rooms of hospitals, sanitariums and similar places.

One of the objects of my present invention is to provide an apparatus that is readily'capable of operating in the manner herein set forth to accomplish the purposes for which it has been designed and to do this in an effective and dependable manner. Other objects are to provide an apparatus of this character that is novel in construction; dependable in operation; compact in the design and assemblage of the parts comprised in its make-up; easy to manipulate and operate; simple and sturdy in the formation of the parts so that it will not readily get out of order; and which is economical to manufacture so that it may be sold to the user for a reasonable retail price. Numerous other objects and advantages will be apparent to persons skilled in the art after the construction and operation of my apparatus is understood from the following disclosure.

I prefer to accomplish the numerous objects of my invention and to practice the same in substantially the manner hereinafter fully described and as more particularly pointed out in the appended claims. The accompanyingdrawings are referred to for better understanding of the construction and operation of my apparatus.

In the drawings:

Figure l is a vertical front elevation of the 40 apparatus with the front wall or door opened or removed.

Figure 2 is a vertical elevation, partly in section on the plane of line 2--2 of Figure 3.

Figure 3 is a top plan of the structure shown in Figure 2 looking at the parts in the plane of line 3-3 thereon.

Figure 4 is a vertical transverse section taken on line 4-4 of Figure 1 looking to the left in the direction of the arrows. ii

Figure 5 is a detail, in horizontal section, of one of the devices for individually disengaging a pointer-pen from the graph-sheet or chart.

Figure 6 is a cross sectional detail of the rewinding roller forthe graph-sheet or chart. ll

Figure '7 is a graphic illustration showing the manner of using the apparatus and applying certain of the parts to portionsof the human body. 1

Figure '1' is a vertical axial section of one of the clutch devices that is used in this apparatus.

The mechanism is housed within a carrying case or cabinet consisting of removable front or door A, the latter being mounted by hinges B on the box-like body, the door being provided with an opening in which a glass panel C is mounted. A base D supports the body, which latter consists of the rear wall E, side walls F, and top G. There is a rectangular plate H that is suitably mounted in the case to provide a main support that is spaced from the rear wall, and brackets I project from supporting plate H to mount a vertically disposed platen or bed J back of the door. The operating mechanism is preferably mounted upon the plate H in the manner hereinafter described so that the plate may be removed with the mechanism without necessarily disturbing the latter.

The platen or bed J is in a plane back of and spaced from the glass plate C extending across the opening in the door as seen in Fig. 4 and provides a flatbed across which the graph-sheet 5 travels in the manner presently to be described. The graph-sheet 5 is preferably a continuous strip of paper which unwinds from a supply roll 6 that is wound upon a core 1 and the ends of the core are provided with trunnions 8 that are removably mounted in vertically disposed bearing slots 9,in the upper edges of spaced brackets i0 secured to the lower portions of the support H. After leaving the supply roll the graph-strip passes upward and over a driving roller ii that is supported by threaded pintles i2 adjustably screwed into horizontal threaded apertures at the ends of spaced brackets II and i4 secured to and projecting-from an upper portion of the supporting plate H. Lock-nuts I! maintain the pintles in their adjusted positions. The marginal portions of the graph-sheet are provided with continuous rows of perforations a and b that are engaged by sprocket-pins Ho and lib projecting radially from end portions of the driving roller II to insure the positive drive of the continuous strip. After passing oil the roller ii the graph-sheet 5 moves downward across the platen J to a re-wind roller it that extends horizontally across the structure near the bottom of the cabinet or casing. One end of the re-wind roller i6 is supported by a threaded pintle ii that is adjustably screwed into a horizontal threaded aperture in the end of the adjacent bracket i0, and a lock-nut ll holds the pintle in adjusted position. The other end of the re-wind roller is supported by a spring-actuated retractable plunger i9 mounted in the adjacent bracket ill and having a finger grasp 20 by which it may be manipulated. In order to dependably anchor the lower end edge of the graph-sheet 5 to the re-wind roller IS the latter is preferably split longitudinally to provide separable members consisting of a longitudinal semi-cylindrical body portion Ito and a longitudinal toric segment Nib, both of which have flat opposing faces, and one of said members is provided with a plurality of short studs iGc that puncture the graph-sheet 5 and enter sockets lfid in the other member as illustrated in Fig. 6.

Suitable actuating mechanism is provided for driving the rollers ii and i6, which said mechanism embodies a small electric motor 2|, one end of its spindle carrying a fan 22 for cooling it and the other end of its spindle operatively connected to a suitable speed-reducer unit 23. The motor and reducer unit are suitably connected together and secured to an adiacent portion of the near-by bracket I that supports the platen. A drivenelement 24 of the reducer pro jects out of the side of its housing opposite the motor and has a beveled or worm gear 2! secured to it that is in mesh with and actuates a beveled or worm gear 26 fast on the intermediate portion of a vertical shaft 21. There are vertically alined bearings 20 for shaft 21 above and below the gear 2|, and other bearings 29 and Ill respectively for the upper and lower end portions of the shaft. Above the upper bearing 28 the shaft 21 has a worm gear ll secured to it that meshes with a worm gear 22 secured to the adjacent end portion of the roller ii to drive the latter in the proper direction to unwind the graph-sheet 5 from the supply roll 6 and move said sheet downward. A worm sear I! is secured to the lower portion of the shaft 21 above the bearing and a worm gear 34 at the end of the re-wind roller ll meshes therewith and is driven thereby. Thus the two rollers II and I. are moved in unison. The gear 24 on the rewind roller however is not fast on the roller I but it is frictionally mounted thereon to permit of a proper amount of slippage which may be necessary on account of the fact that the winding of the strip upon the roller It will progressively or gradually increase the over-all diameter of the roller and accumulating windings of the sheet. V

There are a plurality of inscribing pointers that are actuated by independent mechanisms, each of which is under the influence of a pressure-responsive or pressure-sensitive element. These pointers are identified by the characters X, Y and Z, and since; for the purposes of economy, they are all of the same general construction, only one of them will be described. A pointer embodies an elongated strip of light flexible metal having keyholes in its upper end portion to removably mount it pendently upon headed studs projecting from a carrier 38 that is swingingly connected by a pintle 31 to a U-shaped yoke 38 that has a small friction tube 39 projecting rearward from its horizontal connecting member so that the pointer may be readily and removably. mounted in a frictional manner upon the end of an actuating spindle that is adapted to swing the pointer. A cylindrical spring holder I is formed at the lower free end of the pointer to removably receive the body of a fountain stylus Ii the point or nib of which is adapted to be engaged with the outer surfaceof the graph-sheet when the pointer is in its operative position to inscribe the chart.

The pressure-responsive or pressure-sensitive elements which provide the movement or power for actuating the pointers are in the form of a corresponding number of bellows or like elements 1:, y and 2 that have movement transmitting and movement amplifying devices operatively connnecting them with the respective pointers X, Y and Z.

The bellows a: is for operation under the influence of low pressures and pulsating pressures and the bellows u is for operation under the in-' fiuence of high pressures, said bellows being separabiy employed for ascertaining and recording systolic and diastolic blood pressures of a patient,

and one of these structures is utilised for ascertaining and recording the heart-beats or tions as well as the character of the latter. 4!. Pressure fluid for bellows z: and v is received,

from the source through a hose 42 connected to the end oi a pipe 46 projected out through a wall of the cabinet. The pipe leads to and communicates with one end of the longitudinal bore or passageway of a T-shaped coupling 44 the opposite end of which coupling communicates with a pipe 46 leading to and discharging into the bellows 1:. The lower head of bellows a: has a depending hollow stub 44 that isexternally threaded to screw into a bracket 41 projecting from the main support H and is suitably anchored in place preferably by adjustable lock-nuts 46. The upper head of the bellows :c has an axial guide-rod 49 secured to it that extends up through a hearing or guide bracket 64 also mounted on and projecting from the supporting plate 1!.

Suitable mechanism for transmitting and amplifying the movement of the bellows and guiderod 49 operatively connect said rod to a horizontal rock-spindle II that carries the pointer arm X. The upper portion of the the rod 49 has an elongated rectangular block 62 detachably connected to it by means of friction clutch elements in the bottom of the circular bore 66 of said block. Near its lower end the bore is reduced to provide a conical seat 64 for a fiber friction member 46 that is bored and split and has a cone-shaped lower end to engage the seat 64. A rotatable operating tube 66 surrounds the rod and projects out of the block through {an opening 41 in the top G of the cabinet where its end is provided with a headed finger-grip 66. Near its center of length the tube has a widened portion 49 that is provided with threads to engage threads 66 in the adjacent portion of the bore 46. A coiled expansion spring 6i surrounds the rod 49 between the clutch cone 66 and the lower end of the tube 66 and suitable washers 42 surround the rod at the lower end of the tube and the top of the clutch cone. A set-screw 62a, set transversely in the block, enters a longitudinal groove 49a in the guide-rod and permits relative longitudinal movement of the block and rod but prevents rotation of one with respect to the other. To operate the clutch, the block 62 is held stationary by moving a forked slide 0 on top of the cabinet into slots g on op site sides of the block and the tube 66 is rotated by its finger-grip 56 which causes the spring 6i to wedge the cone 55 down into its seat 64, after which the slide is withdrawn. Reverse rotation of the tube releases the clutch which is assisted by a split spring ring 66 that is imbedded annularly in the cone.

When the rod 49 has been clutched to the block 52 it becomes operatively connected to the movement transmitting and amplifying mechanism and actuates the rock spindle 4i carrying the pointer arm a: so that any movement (even very slight) of the bellows and guide-rod is amplified to 'a substantial extent and is recorded at the free end of the pointer X upon the graphsheet.

The movement transmitting and amplifying devices are mounted in a frame consisting of two laterally spaced vertical plates 94 and 66 that are supported from plate G by horizontal posts 66, and the rod 49 and block 62 extend into and through this frame. A short forked arm 41 is secured to a face of the block with its bifurcation projecting beyond the same, and a horizontal rocker-shaft 44 extends between and is journaled in plates 44 and 44 parallel with the spindle This rocker-shaft has an elongated collar 69 se cured to it with a short lateral lever-arm l4- projecting radially from one end alongside 6 the fork 41, and said lever-arm has a longitudinal slot II in which a trasverse pin 12 is adjustably mounted in a position to enter and engage the fork 61. An elongated lever-arm I6 is connected intermediate its ends to the other end of the collar 46 and is disposed so that its outer (right) end projects between the adjacent pair of posts 44 and its inner (left) and extends towards the block 42 where it has a forked member 14 adjustably secured to it by clamp 3 screws. Up and down oscillation of the leverarm I4 is limited and regulated by means of adjustable stops in the form of set-screws l4 threaded transversely through the adjacent upper and lower posts 44. The fork member 14 is engaged with a cam-pin l4 adjustably carried in a slotted arm 11 projecting radially from a small sleeve 16 fast on the rocker spindle 6! which has bearings in the. plate 64 and 46 of the frame.

Thus, whenever the pressure moves bellows z, 94

or causes it to fluctuate (pulsate) such movement or pulsation is definitely transmitted to the po er arm X in amplified form to be accurately an permanently recorded upon the graph-sheet.

The visual meansfor indicating the movement I) or operation of the bellows a: embodies side-byslde electric lamps 19 and 64 of different colors (preferably of neon gas type) that are supported in spring clips back of windows in the front of the cabinet. The current to the lamps passes through a transformer 6| which reduces the alternating service current of 110-y. to a low amperage such as is utilized for operating neon gas lamps.

The guide rod 49 of the low-pressure bellows a: has a collar 62 adjustably secured to it between the bellows and the guide bracket 44, which said collar has an extension 99 that is provided with a transverse pin 64. Alongside the bearing bracket 64 there is a frame consisting of vertical plates 65 and 66 that are laterally spaced from each other and supported by the reduced portions of posts 61 that project horizontally from the supporting plate H. The compositely formed walking-beam lever arm is fulcrumed intermediate its ends upon a rock-pin 66 that is horizontally disposed between the plates and is journaled therein. A portion 69 of this arm is an insulating bar that extends toward the collar 42 on the guide rod and at its free end there is a fork or bifurcated plate 99 that is adjustably maintained upon the adjacent end of said insulating bar by set screws 9| so that the slotted portion of said fork is engaged with the pin 64 and said arm is rocked thereby whenever the guide rod 49 is moved up or down to the slightest extent. The other end of thelever arm just described has a gear segment 92 secured to it with its teeth engaged with a small pinion 96 on a spindle 94 that has hearings in the frame platen 96-46. One end of the spindle 94 (preferably the end towards the cabinet door) extends through the frame plate 66 and has a small disk 95 secured to it. The edge of this disk has a shallow groove that provides an annular friction seat for an oscillating contact-forming wire arm 96 that is substantially vertically disposed and extends upward to near the top of frame plate 66 where it is provided with a contact block 91.

A substantially U-shaped contact carrier 96 is 75 secured to the frame plate II and is insulated therefrom, and said carrier is located in a posl-' tion so that its lateral arms extend outwardly away from the frame plate upon each side of the contact block 91 just mentioned. Small pinpoint contacts 99 and I00 are carried in the facing portions of the arms of carrier 98 and are adjustably spaced apart a .distance sufficient to allow the block 91 to move or vibrate between them and engage with one and then with the other at each end of its movement. Aconductor wire IOI leads from a source of current supply to the screw which anchors the U-shaped carrier 90 to the frame plate. The oscillating spring contact arm 96 and the pin-point contacts 99 and I00 provide a circuit interrupter or make-andbreak device that is quite sensitive and is operated upon the slightest movement of the bellows x. The lower end portion of the wire forming the oscillating arm 96 is bent into the shape of a flat spring loop I02 and next to this loop the wire is bent into opposing right-angle shapes I00 that combine to form a small square the diagonally opposite halves of which are yieldably urged toward each other by the spring loop I02. The sides of the rectangle I03 tangentially engage in the edge groove of the rotatable disk 95 and are maintained therein by the friction between the parts, such friction being sufficient to permit the arm and the disk to be moved together in one direction a slight distanceuntil the embossment 91 engages one or the other of the pin-point contacts 99, I00. After a contact has been engaged by the embossment 91, the disk 95, by overcoming the friction, will continue its rotative movement in one direction independently of the wire rectangle of the arm 90 but the arm will remain stationary until the disk has changed its direction of rotation whereupon the disk will swing the arm 90 in a reverse direction so that the embossment 91 leaves one pin-point contact and engages the other thereof. An upward movement of the guide rod 49 causes the disk 95 to be rotated clockwise to swing the spring contact arm 90 to the right hand pin-point contact I00 and downward movement of the guide rod swings the arm 90 to the left hand pin-point contact 99.

When the bellows has been inflated so that it responds to pulsating pressures, these pulsations, although they may be very slight, cause a rapid to and fro vertical movement of the fork 90 and arm 89, and this vibratory movement is transmitted in amplified form to the contact forming arm 90 which causes a rhythmic movement of said arm 90 so that it touches one and then the other of the contacts 99 and I00 and thereby causes an alternative flashing of the neon lamps. So long as this rhythmic flashing of the lamps continues the physician or attendant is definitely aware of the presence of a pulsating pressure within the pneumatic system, and when the pressure has been increased or diminished to a degree where pulsations cease to be observed the vibratory movement of the contact forming arm 90 will cease and the embossment 9T thereon will come to rest while engaged with one or other pin-point contacts 99, I00 with the result that the lamps will cease their alternate flashing and only one lamp will continue to burn in steady illumination while the other lamp will have been extinguished. Under this latter condition the operator will be aware of the fact that a critical point of pressure has been reached and pulsating pressure has ceased.

The pointer Y is actuated by the high pressure bellows g which latter element receives the pressure fluid through a pipe I04 connected at one end to and communicating with said bellows and at its other end leading to the lateral stub I00 of the T-shaped coupling 04. The lower head of the bellows 1/ extends through a suitable bracket I00 that is mounted upon the supporting plate H and the upper head of the bellows carries an axial guide rod I01 that extends upwardly 4 and is freely engaged in a bearing bracket I08 projecting from the upper portion of supporting plate H. A light expansion spring I09 surrounds the guide rod between bracket I00 and the upper head of the bellows. At the upper end of the guide rod above the bracket I00 there is a transversely disposed disk I I0 that is securely anchored thereon by a set screw. and slightly above and at one side of the disk III there is a horizontally disposed rock-spindle III that is long enough to extend through the bearing in the bracket I00 and protrude forwardly therefrom to a point above the platen J where it receives the friction sleeve 09 on'the articulated or hinged portion of the indicator or pointer arm Y. An elongated sleeve I I2 is anchored to the rock-spindle I I I and has a spherically headed member II3 projecting laterally or radially therefrom in a slightly inclined or oblique direction downwardly into the contact of the upper face disk H0 at the upper end of the guide rod. When the bellows is inflated the upward movement of its guide rod I01 causes the member II3 to rock the spindle II I and correspondingly move the pointer arm Y. In order to insure return movement of the rockspindle a light coiled spring Ill surrounds such spindle and has one end anchored thereto or to the collar II2 while its other endis anchored to or engaged with an adjacent portion of the bearing bracket.

The pressure creating means is preferably in the form of an elastic bag I I Ii enclosed in a pocket within an elongated fabric ribbon or band IIO that is usually wrapped about the patient's arm above the eblow. The hose 4! communicates with this bag and another hose III leads from the bag to a manually operated collapsible bulb I I0 that has a control valve I I9 and an automatic inlet port I20. The arm band in its usual application is across the brachial artery so that pulsations or heat beats of the patient will be transmitted to the low-pressure bellows 1:. During the time the low-pressure bellows a: responds to pulsations, the neon lamps or indicators will alternately flash due to the vibratory movement transmitted to the oscillating arm 90 by the fluctuations of the bellows 2:. If the physician or attendant continues to inflate the bag II! of the arm-band to a point where the brachial artery is completely collapsed the critical point of high pressure or systolic pressure will be indicated by cessation of the alternate flashing of the lights and such pressure may then be recorded upon the graph-sheet by the pointer arm Y by starting the motor 2| to move the chart sheet 0 a short distance to mark a graph line. The motor is then turned off to stop movement of the graph sheet for the next stage of recording. To ascertain low diastolic pressure the elastic bag is deflated rapidly by manipulating the control valve H9 to exhaust a portion of the pressure fluid. During this deflation the lights will continue to alternately flash. When the pressure has been reduced to a point where the lights cease to alternately flash and one bulb remains illuminated the physician or attendant is then aware of the fact that-the critical point of low or diastolic pressure has been reached and the motor may be again started to record such pressure upon the. moving graph-sheet by means 01 the pointer arm X.

The hollow lower head of bellows 2 which operates the pointer Z extends through a bracket I2I projecting from the supporting plate (3 and is held in position by lock-nuts I23 and the pressure fluid is fed to this bellows through a pipe I23 the other end of which is projected out through a wall of the cabinet. A hou I24 leads from the projected end of pipe I33 to and communicates with the interior of an inherently elastic pneumograph I26 that embraces the chest or abdomen of the patient. Details of construction of the pneumograph are not shown as such devices are quite well-known and in general use. Briefly described, the pneumograph consists of a long spiral spring covered with a flexible rubber tube and both the spring and the tube attached to lateral bosses on end plates in a manner to make the arrangement air-tight. The end plates have means in the form of headed pins for a chain that is used to adjust the structure taut around the chest or abdomen of the patient, and one of these bosses has a small hollow stub for establishing communication between the pneumograph and the hose I24. Thus, expansion and contraction of the chest or abdomen due to inhalation and exhalation will respectively elongate and retract the elastic portion of the pneumograph and cause expansion and contraction.

of the bellows 2. Thus the respiratory movements may be readily recordedon the graphsheet by the pointer arm Z.

The portion of the apparatus which is operated in connection with a patient's respiratory system is quite valuable not only in ascertaining the volume of inhalation and exhalation and the rhythm of these respiratory acts, but it is equally useful in determining some of the underlying causes of abnormalities that may have been noted in the circulatory system. It likewise is valuable in showing the influence on the heart action of retardation of inhalation or exhalation that may have been either intentional or inadvertent on the part of the patient. In order that accurate comparisons may be made, a respiratory record is therefore delineated upon the graph-sheet simultaneously and synchronized with and in a longitudinal parallel zone alongside a record or records made of the circulatory system. Thus, the readings of the respiratory system and the circulatory system are coordinated upon a single graph-sheet. The recording of the respiratory graph is accomplished by pointer Z through the actuation of the bellows z and the movement transmitting amplifying mechanism operatively connecting the bellows and pointer which will now be described.

The upper head of the bellows 2 has a vertical guide rod I26 that extends through a bearing bracket I21 and has an elongated block I28 connected to it by means of a clutch device similar to the device upon the upper portion of the guide rod 48 of the low pressure bellows 32, and which therefore need not be here described. It will be noted however that the operating finger-piece I28 of the clutch in block I28 does not protrude through the wall of the cabinet since this clutch is adapted to be adjusted at the factory during calibration of the apparatus and is not later manipulated or tampered with by the user.

Adjacent the block In there is a frame consisting of laterally spaced vertical plates I30 and III that are supported on horizontal posts I32 projecting from the main'plate G, and a horizontal rock-spindle I33 is journaled in these plates with its forward end extended to the vertical plane of the platen J to receive the friction sleeve 33 of the pointer Z. A short forked arm I34 is secured to a side face of block I28 and a horizontal rocker-shaft I35 is journaled in plates I3II-I3I parallel to rock-spindle I33 with an elongated collar I36 secured to it. The forward; end of this collar carries a short lever-arm I31 that projects radially alongside forked arm I34 ,movement limited and regulated by adjustable stops I40. The inner left portionof lever-arm I38 extends towards rock-spindle I33 and has a forked plate I adjustably secured to it that has its slotted portion engaged with a transverse pin I42 adjustably carried in the adjacent portion of a short arm I43 that projects from a small sleeve I44 adjustably secured on and movable with the rock-spindle I33 which actuates the pointer Z. In this manner the up and down movement of the bellows z is definitely transmitted to the pointer Z in an amplified manner and may be recorded on the graph-sheet to.- delineate the respiration of the patient.

In connection with the respiratory actions of the patient I have provided, devices for visually indicating the inhalations and exhalatlons through the medium of lights or illuminated targets. These devices preferably embody a pair of side-by-side neon gas lamps I45 and I46 of different colors that are mounted back of windows in the front of the cabinet, and the current to these lamps passes through a transformer I4I- similar to and for the same purpose as the previously described transformer 8i. Alongside the frame supporting the respiratory mechanism there is another frame embodying laterally spaced vertical plates I48 and I48 supported from the back plate-G by horizontal posts I50. Journaled in these plates is a rotary spindle I5I carryinga pinion I52 and the forward end of thls'spindle protrudes through plate I48 and has a small edge-grooved disk I53 secured to it. The groove' in the disk provides an annular friction seat for a vibratory contact-forming wire arm I54 that depends vertically therefrom and near its lower end the wire has a contact block I55 secured to it that operates between the lateral arms of a U-shaped contact carrier I56 that is insulated from the frame plate I40. The arms of the carrier I56 adjustably support spaced pin-point contacts I51 and I58 that are alternately engaged by contact block I55 during vibratory movement of the wire arm I54, and a conductor I53 leads from the current supply to the screw which secures the U-shaped carrier to the plate I48. Thus a sensitive circuit interrupter is provided that is similar to that at the left-hand portion of the apparatus. A spring loop I68 is formed in the upper portion of the wire arm I54 above the disk and around this disk the wire is bent into V-shaped angular portions I6I that tangentially and frictionally seat in the edge groove .of the disk. Thus the disk and arm are operated in the same manner as the structure at the left-hand portion of the apparatus to alternately flash the neon gas bulbs I46 and I46 to indicate action of the respiratory system of the patient. In order to operatively connect this mechanism with the pressure-sensitive bellows z the pinion is engaged by a gear-segment I62 on the end of a strip of insulation forming a rocklever I63 which is carried upon a rock pin I64 that has its ends mounted in the frame plates I 46-449. The end of the rock-lever I63 opposite the gear-segment extends towards the block I26 where it has a slotted or forked end I65 that is engaged by a lateral pin I66 adjustably carried in the slotted projecting portion of a short plate I61 that is secured to the adjacent face of the block. Thus movement of the bellows z and its guide rod I26 is transmitted to and actuates the circuit make-and-break devices for flashing and controlling the neon gas lamps I45 and I46 to visually indicate to the physician or operator the inhalation and exhalation movements of the patients chest.

In the present structure I provide means for taking and recording the auricular contractions and the force thereof as may be found in the jugular at the neck of the patient. The purpose of this is to ascertain auricular conditions which may be present and which may not necessarily appear in the other portions of the graph-sheet due primarily to the fact that the low pressure reading is recorded from the force of the left ventricle contraction. This structure embodies a diaphragm unit I66 the sensitive elastic element of which is provided with a horizontally disposed stud I69. The bracket which mounts the unit I68 on the plate G has a horizontal lateral extension I10 projecting from it towards the platen and at its free end it carries the pivot pin I1I of a pendent irregularly shaped pointer I12 having a pen I13 at the extremity of its laterally disposed portion extending in front of the graphsheet, which pen is adapted for engagement with the graph-sheet. The stud I66 is operatively connected with the pointer I12 by a link |13a that is hingedly or pivotally connected at its ends to the pointer and said stud. A pipe I14 communicates with the interior chamber of the diaphragm unit and extends outside the cabinet for connection to a hose I15 leading to a pressure-sensitive tambour element I16 that is placed on the neck of the patient at the location of the jugular and is secured in position by a band or strap I11 that encompasses the patients neck as graphically illustrated in Fig. '1.

For the purpose of providing a convenient means for simultaneously disengaging all the pointers or inscribing elements from the graph: sheet I provide a wide U-shaped rod I16 that is normally disposed back of the lower portions of said pointers close to the graph-sheet. The ends of the arms of the rod areturned laterally outwardly to provide trunnions I16 that are disposed in suitable friction bearings in the walls of the cabinet, and one of these trunnions extends through its bearing to outside the cabinet where it has a finger-grasp I66 secured to it to permit manipulation thereof so that rotation of the trunnions will swing the horizontal reach portion of the U-shaped rod outward away from the graph-sheet and move the pointers outward the desired distance from the platen. This permits easy access to the graph-sheet so that it may be severed at the end of a record and its severed edge engaged with the rewind roller l6.

In operation, the attendant applies the parts to the patient as shown in Fig. 7, having previously lifted the pointers away from the graphsheet, and then proceeds to inflate the air bag III by means of the bulb with the air control valve H6 closed against discharge of air. During this inflation stage the lamps 16-66 will alternately flash, but so soon as the brachial artery has been collapsed this alternate flashing will cease and one lamp will continue to burn alone to indicate that the critical point of high or systolic pressure has been reached. During this stage and the next succeeding step in the sequence of operation the clutch at the top of the rod 46 remains loose so that movement of the bellows a: does not actuate the pointer X during the taking and recording of systolic pressure. The motor may then be switched on to move the graph-sheet, and the pointer Y released by 'brachial artery cease to pulsate the bellows a:

whereupon there is a cessation of alternate light flashes and one lamp continues to burn alone. This is an indication to the operator that the critical point of low or diastolic pressure has been reached. The clutch is then thrown in to operatively connect rod 46 with its movement amplifying means and its pointer X, and the degree of such pressure is then recorded on the graphsheet by releasing the pointer by manipulating rod I16 and starting the motor to permit the pen to inscribe the chart for a short distance, after which the motor is stopped. The next stage is to increase pressure in the elastic bag approximately 10 mm. to 15 mm., above the diastolic critical point. The pointer X will now start an oscillatory movement, due to the pulsating pressure now in the pneumatic system, and its pen will inscribe an irregular or saw-toothlike line indicating the heart beats and disclosing characteristics thereof, during which the pointerYwill continue to trace a line on the chart to show at what pressure the heart-beats are recorded by pointer X.

During the making of the, above-described records the pointer Z will continue to record the patients respiratory actions and the pointer I12 will also record the auricular contractions and the force thereof as found at the jugular in the patients neck. This permits the physician or diagnostician to make definite comparisons and to ascertain and note abnormalities in one graph line that may not have been recorded in one of the other graph lines.

What I claim is:

1. Apparatus oi the kind described comprising a support, a low-pressure responsive device mounted thereon, said device also responsive to pulsating pressure, movement transmitting means actuated by said device, an inscribing pointer actuated by said means, a high-pressure responsive device on said support, movement transmitting means actuated by said high-pressure device, a second inscribing pointer actuated by said last-mentioned means for recording highpressure and also-the pressure at which pulsating pressure is recorded, a movable continuous graph-sheet cooperating with said pointers; a pressure-creating appliance applied to an artery of a patient and communicating with both of said pressure-responsive devices for actuating the latter, an inherently elastic pressure-creating element applied to the chest and operated by respiratory actions of the patient, a pressureresponsive device communicating with and actuated by said respiratory element, means connected with said last-mentioned pressure-responsive device adapted to record respiratory actions on said graph-sheet adjacent the arterial record whereby the separate recordsare disposed in coordinated relation to each other on said graphsheet, and mechanically actuated means for advancing said graph-sheet during movements of the recording elements of the apparatus.

2. Apparatus of the kind described comprising a plurality of pressureresponsive devices, a pressure creating appliance applied to an artery of a patient and communicating with certain of said devices whereby different degrees of pressure and pulsating pressure are adapted to be supplied to said responsive devices, an inherently elastic pressure creating element applied to the chest and afiected by respiratory actions of the patient and communicating with another of said responsive devices, a pressure creating appliance affected by auricular action of the patient, a plurality of movement transmitting mechanisms each operatively connected with and actuated by a pressure-responsive device, a plurality of inscribing pointers each actuated by a transmission mechanism, a continuous graph-sheet common to all of said pointers, whereby the separate records inscribed by said pointers are disposed in coordinated relation to each other and the pressure at which pulsations are recorded is indicated, and mechanically actuated means for advancing said graph-sheet.

3. Apparatus of the kind described embodying means including a closed conduit in which varying pneumatic pressures are produced, a pneumatic device communicating with said conduit and sensitive to the pressure therein, a longitudinally reciprocable rod actuated by movement of said pneumatic device, a rock-spindle disposed transverse to said rod, a transverse member on said rod adjacent said spindle, a lateral element on said spindle and having operative connection with said transverse member, a vibratory pointer actuated by said spindle, and a mobile 'chart co-acting with the free end of said pointer and movable independently thereof.

4. Apparatus of the kind described embodying means including a closed conduit in which varying pneumatic pressures are produced, a pneumatic device communicating with said conduit and sensitive to the pressure therein, a longitudinally reciprocable rod actuated by movement of said pneumatic device, a rock-spindle disposed transverse to said rod, a disk on the portion of said rod adjacent said spindle, a lateral arm adjustably mounted on said spindle and having a portion engaged with a face of said disk, a pointer mounted upon and actuated by said spindle, and a mobile chart with which the free end of said pointer co-acts, the movement of said chart being independent of the movement of said pointer.

5. Apparatus of the kind described embodying a bellows having an anchored portion, means for creating pressure in said bellows, a rod extending from a movable portion of said bellows, a transverse member on said rod remote to said bellows, a rock-spindle disposed with its axis transverse to the axis of said rod, a lateral element on said spindle that is operatively engaged with the transverse member on said rod, 9. mobile chart, and means carried by said spindle for indicating the movement thereof on said chart.

6. Apparatus of the kind described embodying a bellows having an anchored portion, means for creating pressure in said bellows, a rod extending from a movable portion of said bellows, a disk on said rod having a face disposed transverse to the axis of said rod, a rock-spindle having its axis transverse to the axis of said rod, a lateral arm adjustably anchored on said spindle and having its free end contacting the said transverse face of said disk, a mobile chart, and a pointer carried by said spindle and adapted for recording movements of said spindle upon said chart.

7. Apparatus of the kind described comprising means including a closed conduit in which pulsating and non-pulsating pressures are produced, a pneumatic device sensitive to high-pressure and having communication with said conduit, said device being unaflected by pulsating pressure, a rock-spindle having operative connection with and adapted to be actuated by said high-pressure sensitive device, a pointer-arm actuated by said rock-spindle, a mobile graph-sheet co-opcrating with the indicating portion of said arm, a second pneumatic device communicating with said conduit, said last-named device being influenced by pulsating pressure, and an indicator operatively connected to said second pneumatic device and cooperating with said graph-sheet, whereby the first-named arm is adapted to indicate the pressure at which pulsations are indicated by the second-named arm.

' THOMAS BRADFORD.

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