US2366030A - Method of and means for inducing artificial fever - Google Patents

Description

1944- I F. c. HOUGH-TEN ETAL 2,366,030

METHOD OF AND MEANS FOR INDUCING- ARTIFICIAL FEVERS Filed Aug. 5, 1940 I 2 Sheets-Sheet 1 i 24 )1 7 I l F 1 1133i 36 E a? 1' Y5 .5 .#;}2Z;T fi z Eff/cr- Dec--26, 1944- F. c. HOUGHTEN ET AL 2,365,030

METHOD OF AND MEANS FOR INDUCING ARTIFICIAL FEVERS 2 SheetsSheet 2 Filed Aug. 5, 1940' R O T N E V N Patented Dec. 26, 1944 UNITED STATES, PATENroFHcE METHOD OF AND MEANS FOR INDUCING ARTIFICIAL FEVER Ferry C Houghten and Murray B. Ferderber, Pittsburgh, Pa.

Application August 5,1940, SerialNo'.351,l56

2 Claims. ((31.128-373) Our invention relates to a method of and an apparatus for applying fever therapy to individual portions of a human body by conditioned air. In our application, Serial No. 162,626, filed September 7, 1937, we disclosed a method of and an apparatus for inducing artificial fever generally in the human body.

Heat has been used therapeutically in many forms for hundreds of years, including such modalities as packs, steam .baths, electrical applications, such as short wave, diathermy, etc. Any or all forms are used to produce the same effect, i. e., increased circulation of the part in; volved. Some means are considerably safer than others, combining simplicity, flexibility, and control of conditions. r

I-Iyperpyrexia (fever therapy, 'hyperthermia, etc.) has become an accepted form of treatment that has been employed quite successfully where its uses are indicated. However, there are numerous patients who require some form of heat therapy-but who object to general treatment where only one extremity may be involved. Then, too, there are patients who have reached the age or who are prematurely physically unsuited for general therapy These patients require treatment of the localpart-to relieve them of their symptoms, which are frequently quite severe.

Physiologically, heat produces dilation of blood Vessels which in turn increases the circulating volume of the part involved. Capillaries which are normally very small became engorged with blood, the elements of which are instrumental in producing relief of symptoms and in many cases complete resolution of the pathological processes, Because of the stimulated circulation, the affected area receives blood supply capable of handling the metabolic processes and relieving symptoms which frequently are severe and are caused by the accumulation of metabolites.

The apparatus disclosed in our previous application consists generally of a box large enough to receive and accommodate the entire body of the, patient from the neck down- The head of the patient extended out from th box, while the body of th patient was subjected to a circulating stream atmosphere of water saturated air.

That large apparatus was employedwhere general fever therapy treatment was necessary.

We have found certain conditions and ailments of the body, however, for which it was not necessarily desirable to apply general fever therapy.v

However, the application of localized fever therapy solely to an affected portion of the body has brought about unexpectedly beneficial results,

and the method of operation and the apparatus described herein have been developed to permit the local application of fever therapy treatments without affecting the healthy or normal portions 1 of the body.

We have also found that certain back ailments have responded most satisfactorily to local applications of moistheat, according to the present process. i

The present apparatus in one form consists substantially of a cylinder three or four feet long, and about fifteen or sixteen inches internal diameter, with one end of the cylinder open to receive an arm or leg, after which that end of the cylinder is closed by a soft rubber curtain, tucked around the arm or leg. At the closed end ofthe cylinder, is disposed an air-conditioning unit consisting of an'air circulating duct in which a water spray is arranged to establish an air stream and circulate the air within the cylinder while humidifying it at the temperature desired. The spray head may be supplied from the ordinary hot and cold water systems in any building, or from any auxiliary water circulating device.

Evidence from work done with apparatus of this type has definitely shown that water saturated atmosphere will produce the desired increase in temperature in the body, and is therefore particularly desirable because the danger of burns to the skin of a patient is greatly lessened on account of the low dry bulb temperatures.

For example, inmost industrial hospitals the whirlpool andfoot baths are used for soaking and heating aninjurecl extremity. The temperature of these baths usually ranges from 108 to 120 F., and mostfrequently the-lower range is used because discomfort becomes too great at the high temperatures. Since this apparatus uses humidified air and since theheat transfer from the air to the body surface is not as great the air temperatures may be carried to a higher range without any discomfort and definitely without danger of burning. To verify this, one extremity was placed within theapparatus enclosure and the other in a water bath and the temperatures of both raised simultaneously. When a temperature between 112 to 115 F. was reached, the foot was withdrawn from the water bath because of The apparatus and the method of operation to establish the desired treatment of the selected portions of the body of the patient are shown in the accompanying drawings, in which Figure 1 is an end elevational view of a unitfor treating the back part of the body of a patient, and consisting of an arch-shaped cover to fit over the back of the patient, with a principal unit mounted on the side of the cover to supply a circulating stream of moist air at the desired temperature;

aspirator to draw air from the space or com partment I2a within the shell l2, and to force that air in and around through the conduit I9 and back into the compartment I2a through the upper or outlet end 24 of the, conduit.

The inlet end 23 is preferably disposed on a lower plane than the outlet end 24 in order to take advantage of the natural stratification of the heated and moistened air as it is supplied to the treating chamber I2a. During the circulation of the air, as the air is heated and moistened by the water spray, and then supplied to the compartment I2a, that heated air tends to spread or stratify over the upper space in the compart- 1 5 Within the compartment between the top of the compartment and the bottom of the compartment is relatively small.

Figure 2 is an end elevational view of therapparatus in Figure 1;

Figure 3 is a plan view of the apparatus in Figure 1;

Figure 4 is a side elevational viewof an apparatus for accommodating and treating an arm or a leg;

Figure 5 is an elevational view of the control unit that is mounted at the end of the apparatus in Figure 4;

Figure 6 is a side elevational view of an apparatus similar to that in Figure 4, except that it is provided with a control unit of a different yp Figure 7 is an end elevational view of the air conditioning or control unit at the. end of the apparatus in Figure 6; and

Figure 8 is an elevational view at the open end of the apparatus in Figure 6, showing the opening in the curtain through whichthe arm or the leg of the patient extends during treatment.

The apparatus I0 shown in Figure 1 comprises,

briefly, a rubber mat or mattress II upon which the patients body is to rest during treatment, and an arch-shaped cover I2 to fit over the portion of the body to be treated and to rest upon the mattress I I, to confine the moist treating air to that portion of. the bodythat isv to be treated. The open ends of the cover I2 are provided with suitable closures such as rubber curtains I3 and I4 that confine the moist air to the volumetric space contained in the part of the cover over the body that is to be treated. Upon one side wall I6 of the cover or shell I2 is mounted a bracket or frame I5 that is integrally secured to the side wall I6 of the cover to serve as a support for a plate I! upon which is mounted a water spray.

head I 8 and a cooperating conduit I9.

The side wall I6 of the unit I2 is provided with a large opening 2| which is entirely surrounded by the bracket frame I5, so that the space or compartment within the shell I2 will communicate with the space within the frame I5, and so that the air in the shell I2 can be conditioned or moistened, heated, and circulated by the action of the water spray dropping from the head i8 down into the conduit I9. A suitable drain 22 carries off all excess water from the spray, and all water in excess of enough to saturate th circulated air stream.

As the water spray drops down vertically into the inlet end 2-3-of the conduit I9, it serves as, an

ment I2a. The temperature drop or gradient However, as the warm, moist air comes into contact with the portion of the body being treated, the moisture in the air condenses on that portion of the body, and a corresponding amount of heat that was stored in the air is delivered to the body, and the temperature of the air is correspondingly reduced. This cooler air thereupon drops to a lower level in the compartment. That cooler air is then drawn back up into the conduit, in which it is i e-conditioned by the water spray, and then forced through the conduit by the same water spray to re-circulate through the compartment in the shell. The reverse travel of the moistened and warmed air through the rising portion I9a of the conduit serves to remove any excess moisture that might otherwise be carried in the circulating air stream. Such excess moisture and the part of the water spray that has not been absorbed by the air stream pass out of the conduit at the bottom through the drain 22.

The water spray head I8 may be supplied with water of any desired necessary temperature by suitably controlling the the valves 26 and 2'! respectively connected in hot and cold water circuits that are connected to supply water to the spray head l8. 1

In order to determine the temperature of the conditioned air stream, an opening 28 is provided at the top of the shell I2, to permit a thermometer to be extended therethrough into the compartment I 2a.

The foregoing unit with the shell I2 may, of course, be applied to any portion of the body to be treated, but is primarily intended to treat different parts of the back of the body of the patient, from the shoulders down to and including the hips.

The apparatus shown in Figures 4 and 5 is intended primarily for use in treating an arm or a leg. This unit 30 comprises in general a box 3I having a cylindrical inner space or compartment 32, with a rubber closure 33 at one end of the boxand with a closing plate 34 entirely closing the other end of the box. The rubber closure 33 is provided with an opening through which an arm or leg of the patient may extend to be disposed inside of the operating chamber 32 of the box.

Within the operating chamber is disposed a rubber mat or platform 35 to support the arm or leg that is to be treated.

At the closed end of the box, the end wall 34 consists of a plate which is arranged to be suitably anchored by bolts 36 around the peripheral edge to a suitable flange or peripheral section of the box 3|.

* The end wall plate 34 serves asasupport for a water pipe 31 extending through the plate 34 to a permit its outer'end to be connected to a suitable proper manner in" the air conditioning unit from the inlet opening 51 to the outlet or supply opening 58, the space in the shallow shell 53 is divided substantially into three compartments 6|,

-62,and B3.

The lower end of the compartment 6| terminates substantially in the inlet opening 51 through which the air is drawn from the lower levels of the main compartment of the box, The upper end of the compartment 6| leads to the upper end of the middle compartment 62, so that the operation of the spray will draw the air upward as an aspirator to draw the air from the'box into the conduit 45. The air thus drawn into the conduit is heated or cooled, according to the temperature of the water, and is then propelled onward through the conduit 45. The other arm 46 of the conduit rises vertically to an outlet opening 41 that is disposed at a higher level than the inlet opening 44. i

The downward movement of the water spray from the spray head43 moistens, heats, or cools, and propels the air as already mentioned. The propelled air is caused to move downward under the spray and back upward through the section 46 of the conduit, and out through the outlet opening 41 into the space of the compartment 32 in the box 3| In the form of control conduit shown in Figures 4 and 5, the outlet opening 41 may be reduced in diameter to provide a constricted throat at the outlet, in order to impart an increased velocity to the travelling air supply where it leaves the conduit, if the treating box 3| is unusually long.

jected from the outlet end of the conduit, will tend to stratify or distribute itself at the upper levels of the box. When air is withdrawnto the inlet opening 44 by the spray, the air at the upper levelswill drop and will assure movement of the saturated air throughout the entire space of the box in which the arm or leg to be treated is dis.- posed.

A drain .48 at the bottom of the box removes all of the condensation that accumulates in the box 3|, and removes also the excess water from the sprayhead 44 that drops down tothe drain 48, through an opening 49 at the bottom of the conduit.

In Figures 6; 7, and 8, we have illustrated a local treating unit 50 in which the box 5| itself is similar to that shown in Figure 4, but the air conditioning unit 52 is somewhat different in construction.

It is arranged to be applied to or disconnected from the end of a box 5|. unit 52 is shown as consisting of a shallow recessed circular shell 53, provided with ,a straightened peripheral flange 54; by means of which the shell 53 may be secured to the end of the box 5| through the medium of anchoring bolts or screws 55.. In order to control the air movement in a predetermined path, a perforated plate 56 is disposed between the shell 53 and the box 5| The plate 56 is provided withtwo diametrically spacedopenings 51 and 58, disposed substantially as indicated in Figure '1.

In order to moisten, and to heat and move the stream of air, as in the other modifications, a spray head 59 is supported on the shell 53, with the connecting pipe 60 extending back through the back of the shell for connection to a suitable source of water supply.

In order to control :the air movement in the The air conditioning from the inlet'opening 51 through the compartment 6|, and then force it downward through the compartment 62, and thence into and upward through the compartment 63 to the outlet opening 58. Two spacers or baflies 65 and 66 are disposed adjacent to the spray head to establish the intermediate space in the middle compartment 62, within which the spray from the spray head is to be confined. The outer surfaces of the bafiies .65 and 66 are rounded substantially to the curvature of the wall of the shell 53. The lower end of the baiile 65 is provided with a tail piece 65a that is disposed along the peripheral edge of the inlet opening 51, and out to the inner surface of the wall of the shell 53.

The upper edge of the baflie 66 is similarly provided with a tail piece 66a that extends out to the wall of the shell 53, and substantially along the edge of the outlet opening 58. These two tail- .pieces insure that the'air circulation will proceed along the desired path from the inlet opening 51 up through the compartment 6| and down through the compartment 62, where the air will be moistened and heated, or cooled, by the water spray, and then forced by that spray upward through the compartment 63 and out through the outlet opening 58 into the main or working chamber of the box 5| t The location of the inlet opening 51 is such as to be substantially in the region of the lowermost portion of the main compartment in the box. The outlet opening 58 leading to the box is located practically along the upper region of the main compartment of the box, so that the moistened and heated air will tend to stratify in horizontal planes throughout the length of the main chamber of thebox 5|. As the air is withdrawn from the lower regions of the box during the op eration of the water spray, the entire volume of air in the box tends to move downward as a blanket upon the arm or leg that isdisposed in thebox, tobe treated by the hot moist air.

In each of the forms shown herein and intended for local applications, the air conditioning system is of the general dew-point type, in which the highly atomized water spray at the upper end of a small duct supplies both the motive power for circulating the air and the heat and moisture for saturating the air at the desired temperature. The downward movement of the spray gives the air a momentum that removes it from the lowerportion of the box and delivers it in saturated. condition at the desired elevated temperature to the top of the working chamber of the box. By reason of the stratification of the saturated heated air as it is supplied to the working chamber, there is little or no temperature gradient throughout a horizontal cross-section, with a minimum controlled gradient from the top to the bottom of the chamber.

With a forty pound water pressure and a four inch duct throughout the air conditioning system, 9.8 cubic feet of air per minute are removed from Without insulation twenty- .to thirty gallons of water per-hour are suflicient for satisfactory conditions in the box, andif the cylinder is insulated to insure-againstexcessive heat loss to the surrounding atmosphere-a considerably smaller water volume will ,suffice. A water temperature of 130 F. will produce a uniform saturated atmosphere of from 120 to 125 F. Since the air is saturated :upon entering the box.

and loses heat before being returned to the air conditioning part of'the cycle,:saturation is'insured throughout.

From a comparative standpoint the whirlpool baths using rapidly'agitatedwater from 108 'to 120 F. have been used in. industrial hospitals to produce a hyperemia (increased blood supply). The upper range of temperature. in. this water bath is apparently too great .for comfort and could conceivably cause certain diflicultieswhich might arise in a patient with.impairedrcirculation in the extremities. The abilityof a patient -to tolerate temperatures between 114 and 120 F., saturated, is outstanding sincemostof the cases are treated at these temperatures without danger of complications. From experience ithas :been

I found that it is necessary'to treat a pateint one to three hours to producedesired'effects; and-the index of improvement increases with each succeeding treatment. Usually a course of treatments would consist of thirty-six hours at a predetermined temperature usually divided into twelve treatments of'three-hours each given daily or every other day. Theincrease in pulse rate is fairly insignificant, andthe rise' in leucocyte count would average about 1500-cells, which may be purely a personal variation "in making the counts. The risein body temperature resulting from this treatment is insignificant and varies from no rise to a maximum rise of from 1 to 1 /2" F. This increase doesnot afiect even those patients suflering from severecardiac lesions.

In comparative tests'ofiheat applications by short wave, by infra-red'rays, and by saturated air at slightly elevatedtemperatures according to the method describedherein and by means-of the present local apparatus, itwas found that the most rapid temperature increases occurred using short-wave,and the deepitemperature'was elevated as high as 108-109 F. 'When the shortwave generator was disconnected, the deep temperature dropped immediately, and it reached'its normal within twenty=minutes. Using infra-red heat the deep temperature response was not so rapid nor was the temperature rise as great; and removal of the heat sourceprecipitated a rapid fall of the deep temperature. Moistheat produced a considerably slower deep temperature rise, not quite as high as short-wave, but even when the heat source was removed and' cold water circulated through the apparatus at a temperature of-GO" F., the deeptemperature persisted for one-half hour before it started to drop; and it was back to its previous normalin an hour. Thesignificance of this comparison is quite important in view of the factxthat moist heat treatments are given for two or three hours-without producing pain or burns.

For example, dilatation occurs-slowly but progressively, down tothesmallest capillaries; Since this is not sudden (as inshort-wave), fatigue of the nervousmechanism controlling the dilatation or constriction does not occur. Therefore, we can give long. periods .oftreatments which-are always the-bottom of the ibox,--iheated andsaturated to the desired temperature, and returned to, .the upper portion.

more beneficial than short ones. .Theibodymust have time'to-adjustitselfto any'change, and sud= den forms of treatment, short-lived, are not 'asbeneficial. This apparatus can be used'for-two to three or more hours without danger.

In view of the gradual'dilatation, the bloodpressure in the body is substantially unchanged, and

the pulse rise, if any, is negligible. At the same ment involved, it is, therefore, possible to treat an arm orv leg of a person whose heart would not permit the application of general uncontrollable heat therapy.

By means of the present equipment, it is possible also to control the ratio of the area of the surface to which the heat is applied tothe-area of the untreated surfaces,'which serve as heatdissipating areas.

The important feature of the present apparatus iszthefact that it'provides a tolerable'heat which the patient can tolerate for a substantial period of time, running continuously into hours, without anydeleterious effects. The long-continuous treatment is, of course, advantageous since it rovides the greatest healing eifect by enabling the system to remove the products of the ailment over the extended period of continuous treatment.

With this apparatus there'is no burning, either of the-skin or internal parts of the body. There is no shock due to sudden application of heat energy in. a form that compels the body to absorb it more suddenly than thebody can adjust itself to absorbthat amount of heat energy. The beneficial action in the increased dilatation locally is not attended by any overloading on a heart that is unable to tolerate-the more than normal-function.

In our experience with the present equipment, we have employed saturated atmospheres throughout, andhave found that fully saturated atmospheres have provided optimum conditions, since-lower dry bulb temperatures could be employed.

In order, however, to be able to control the percentage of moisture containedin case less than complete saturation might be desired, we may dispose a heating element 10 just ahead of the outlet end of the air conditioning conduit, as shown, for example, in Figure '7. This heating element 70 may be utilized if desired, and heat from an external circuit through conductors H to superheat the saturated airstream, and thereby reduce the relative moisture contained to a value below complete saturation,

Our inventionisnot necessarily limited'to the specific details of construction that are shown, since these may be variously modified without departing from the spirit andscope of the invention, asset forth in the appended claims.

We claim as our invention:

-1..An apparatus forapplying moist heat to a localizedarea of a. human body, comprising an enclosure to fit over the portionof the body to betreated and providing a relativelyfree main space compartment within the enclosure; and means for circulating a stream of saturated air through the compartment saidmeans comprisposed at one end of the J-conduit vertically, and

operative to, drop its fluid spray into the conduit and to aspirate the air from the main compartment into and through the conduit, and thence having a drain at its lower end for the removal of any water from the spray that is not absorbed by the air stream, the spray end of the conduit being disposed to draw the air from the lower back into the main compartment; the conduit levels of the main compartment, and the other ber base or mattress to receive and support th portion of the body to be treated; a cover of inverted U-shape to fit over that portion of the body and to removably seat itself on the rubber base with a free space compartment above the body; a soft rubber curtain at both ends of the cover to close the compartment above the body of the patient; and means supported on the side wall of the cover to heat and saturate and circulate a stream of air through the compartment, said means comprising a conduit of substantially J-shape, both ends communicating with the space compartment, the lower end of the conduit being at a lower level and'the top end of the conduit being at an upper level, the lower end opening of the conduit being fully open to provide a low velocity orifice for the air stream from the space compartment, and the top end of the conduit being reduced in diameter to provide a, high velocity orifice for the air stream to be supplied to the compartment; and a water spray head disposed at the lower end opening of the conduit to drop its spray vertically into the conduit to heat, moisten, and circulate the air stream through the conduit and through the space compartment.

FERRY C. HOUGHTEN. MURRAY B. FERDERBER.

Images