US2084804A - Anesthetizing apparatus - Google Patents

Description

June 22, 1937. w. R. HENION ANESTHETIZING APPARATUS Filed NOV. 25, 1952 4 Sheets-Sheet l I NVENTOR WALTER F1.HEN10N WZi/F, ATTo Rlvfiya June 22, 1937. WQR. HENION ANESTHETIZING APPARATUS Filed Nov. 25, 1932 4 Sheets-Sheet 2 INVENTOR .4 TTORNEYS- June 22, 1937. w. R. HENION ANESTHETIZING APPARATUS Filed Nov. 25, 1932 4 Sheets-Sheet 3 INVENTOR WALTERRHENION 5'19 P A-r-ronwzys Patented .June 22, 1937 UITED STATES PATENT OFFICE to .The Heidbrink Minn., a corporation Company, Minneapolis, of Minnesota Application November 25, 1932, Serial No. 644,219

37 Claims.

This invention relates to improvements in anesthetizing apparatus and is particularly concerned with means operable by the patient to keep the patient in a state known as analgesia,

r in which consciousness 'is maintained but no pain is felt. The condition resembles twilight sleep in which the patient cannot feel pain but retains voluntary motor ability, The present de--' vice is useful in obstetrical cases.

The invention takes advantage of the reflex and/or voluntary gripping tendency of a person in pain, this gripping tendency being due to nervous tension. In the present devicejas gripping progresses, more of the analgesic substance is delivered to the patientfor breathing, and as gripping is lessened, less is delivered.- On the other hand by this device, an anesthetic substance can be delivered or shunt oif independently of the patient and while the patient continues to grip the control.

An important feature of the invention is gripping action by the whole hand, as distinguished from the, pressing of a button or the pressure of a control device held between the thumb and forefinger. There is a tendency for a person in pain, for example when in the dental chair, to

grip the arms of the chair and this natural gripping action while the arms rest on the chair or on the arm of the chair is taken advantage of.

I am aware that there have been some devices which purport to properly control analgesia but, insofar as I am aware, no one has ever produced a really practicable device by which the patient can himself successfully maintain the proper condition of analgesia.

The present device provides means whereby there are, when the patient is breathing air, no back pressures in any part of the mask or in the breathing tube. The device further provides means whereby the flow of analgesic substances is automatically stopped before the patient becomes unconscious-and provides means whereby breathing of atmospheric air may be had, without removal of the mask and without removal of any part of the apparatus. In this device, the

analgesic agent may be at, all times under the control of the patient and immediately the flow of anesthetizing agent is stopped, air can be drawn through the breathing tube only under atmospheric pressure.

The device can be used as an attachment on any type ofljmachine, or can be incorporated as an integral part of any type of machine either for machines of continuous flow type or of the intermittent flow type.

Features of the invention include means for controlling analgesia by the gripping action of the whole hand; the delivery of exhalation of the patient at a point remote from the patient and operator; the control of delivery, breathing bag, and air intake passages, by a single valve means; means for by-passing gas around the valving means; the delivery of this by-passed gas into the breathing tube at a point remote from the air intake opening; means adjustable by the operator for obtaining a supply of analgesic substance after the patient has closed the main delivery valve; means for varying the timing; means for delivering an additional quantity of anesthetizing substance during the timing period, and all details of construction and arrangement of the parts, as disclosed.

Objects, features and advantages of the invention will be set forth in the description of the drawings forming a part of this application, and in said drawings Figure 1 is a side elevation of the apparatus of this invention;

Figure 2 is a, top plan;

Figure 3 is a vertical lonigtudinal section through the valve-controlled gas delivery portion of the machine, taken approximately on line 3-3 of Figure 2;

Figure 4 is a plan section taken approximately on line 4-4 of Figure 3, but with the valve means moved to a control position opposite that shown in Figure 3;

Figure 5 is a fragmentary vertical section corresponding to Figure 3, but with the valve means releasably locked in the position shown in Figure 4;

Figure 6 is a side elevation illustrating the device as an attachment for any suitable type of machine for delivering anesthetizing substance;

Figure 7 is a vertical section on line 1-1 of Figure 2, illustrating auxiliary pressure regulation means;

Figure 8 is a vertical section through the pressure regulator and related parts, taken on line 8-8 of Figure 2; and

Figure 9 is a vertical section taken on a line corresponding to that of Figure 3, illustrating means for timing an extra supply of anesthetizing gas after the patient has sufiiciently lessened the grip of the control element to stop delivery of anesthetizlng substance.

Numeral l indicates the top portion of a floor standard acting as a support for the apparatus. Mounted on the standard is a frame structure including various tubular members forming'pasof this structure includes the yokes 2 which may be of any preferred form, which support the gas containers. Pairs of yokes are generally provided, two for containers of nitrous oxide, for example, and two for containers of oxygen. In regard to the major features of this invention, there is no intention to limit it to any particular type of anesthetizing apparatus. Moreover, only those parts of the apparatus have been shown in the drawings, in detail or otherwise, which seem essential to the understanding of the functions involved in this general class of machine.

The gas containers have not been shown. Referring to Figures 2 and 8, the passage into which the gas is delivered from the gas or vapor container (held in the yoke) is indicated at 3. This passage communicates with pipe 5 which communicates with horizontal passage 5, which connects with passage 6 to the pressure regulating device, generally indicated at 8 and ofgany preferred form. In this case, there are two of these devices, one to regulate the oxygen and. one to regulate the nitrous oxide. The valve mechanism for this pressure regulator includes a piston-like valve l which is part of yoke ii attached to diaphragm l2. The diaphragm is adjusted by spring 13, the compression of which is controlled .by the usual means. When this adjustment takes place, the element i0 is raised or lowered, as a piston, against the action of the spring M which acts in opposition to the spring l3, and moves the valve l0 to seating position.

The valving washer i cooperates with the end of a plug or seat Hi to control passage ll communicating with the passage 6. The gas escapes past the valve into chamber 20 and thence into a passage indicated in dotted lines at 2! which, in Figure 8 of the drawings, is at the's'ame level as the passage 6 and appears at the center of the figure. This passage 2i is also indicated in dotted lines in Figure 2. The gas, after passing through the regulator, enters the passage 2| and from this passage is delivered into-passage 22, see also Figure 7. The passage 22 is formed in a cross arm 24, and this passage islin communication through tube 25 with a suitable pressure gauge indicated at 26, see also Figure 1. There are two of these pressure gauges, one for oxygen and one for nitrous oxide, and they may be of any suitable construction,,and, therefore, have'bee'n only diagrammaticallyrepresented in the drawings. The gauges indicate pressures corresonding. to regulator adjustments. The passage 22 is constricted as at 21 and leads into an annular mixing chamber 28 (see also Figure 3) from which chamber it is delivered through-ra-' dial passages 29in plug 30 .into an axial passage 3| of the plug. The plugis in threaded engagement with atubular member- 32 having passage 33 leading forwardly, see also indotted lines in Figure 2. This passage is designated herein as the delivery passage for the mixed or unmixed anesthetizing fluid or gas or vapor, or oxygen. The course of the fluid has only been traced for one side of the machine. The course for the opposite side of the machine is substantially identical. It will be understood that gases of difierent kinds can be delivered from opposite sides of the machine to the annularchamber 28, where they are-mixed, and whence they are delivered into delivery passage 33. The arrangement or position of the passages of the machine, and of I the various controls, are features of the invention.

' Referring to Figure 7, which is a section on line any type of machine is important.

aoeasoa sages for the anesthetizing fluid. The lower part 'ii of Figure 2: Each passage 22 leading from the regulator to the mixing channel 28 is provided with a needle valve 23 operable for adjusting the flow of the gas in a manner to compensate for pressure gauge inaccuracy. Each valve seats inthe end of the corresponding restricted passage 2l. This is a feature of the invention.

An important feature of this invention relates to the control by the patient of the delivery of the anesthetizing or analgesic substance from the'passage 33 to the inhaler. The construction now to bedescribed may be an integral part of I the new machine, above described, or it may be an attachment, and its use as an attachment for In Figures 1, 2 and 3, it is shown as an integral part of the machine, while in Figure 6 it is shown as an attachment which may be connected to the delivery passage 33 (or equivalent passage) of any machine .of the general class previously described.

Another feature of the invention relates to a patient-controlled means interposed in the breathing line between the point of delivery of the gas supply and the patients nose, and performing three functions, to wit: control of gas which a breathing tube 38 is attached, and a pas-.

sage 39 in extension 40, the extension being provided for .the attachment of a breathing bag M. The passage 36 is formed in a. tubular extension d2, but it will be understood that this extension may be dispensed with and the casing may simply have an opening-at thepoint 43.- The inhaler or mask is indicated at 38?. tube connectsf'it' with the -=tube 38, but tube 38 may be connected directly to elementfl38 and such a connectionismhntemplated herein,

valvejmeans, controllable .by the patient ina manner hereinafter to be described, is provided for simultaneously controlling the delivery of gas or anesthetizing substance from delivery passage 33 through the passage in the fitting 45 into the chamber 35, controlling entry of the gas through the bag passage 39, and controlling entry of air into the chamber 35 through the passage 36.

The invention also contemplates the separate con- ."trol of any two ofthese passages, for example i the delivery and air intake passages only.

- motion being controlledby a plunger 48 slidable in the casing and ,s'u itably connected to control wire 49, which wire passes through a tubular member 50 rotatable uponxextension 5| of the casing 52 in which the ch'a'mber'35 is formed. The wire passes through a. section of flexible tube 53, see Figure 3, and thence through a metal This chamber a: The usual double (or flexible) tube and into the tubular portion 1 I 57 of a hand grip element 58, seeFigure 1'. This tubular portion is suitably secured to' a handle or grip section 58 which has somewhat the form of the grip of an automatic-pistol. The element 58'may represent the arm of a, chair in a grooveof which the trigger, or button Gil-is pivoted,v or; with which 'arm it is operably attached many suitable manner. The positioning of this trigger the fingers.

or its equivalent in any way on the arm, is a feature.

The end of the control wire 49 is attached to a lever or trigger 60 suitably pivoted to the grip section 58. This trigger normally, as before gripping by the patient, stands in the position shown, and suitable depressions 6| are provided to receive This form of grip is a valuable feature of this invention inasmuch as it takes advantage of the gripping action of the entire hand to control the delivery of the anesthetizing agent. An important object is to produce and maintain a condition of the patient known as analgesia, in which there is a loss of sensation to pain, without total loss of consciousness, and in which voluntary motor ability is retained. It will be understood that this idea of utilization of the gripping action of the entire hand, or more than two fingers, particularly as distinguished from control by means -of the thumb and forefinger, can be applied to the arm of a dental chair, for example, which arm the patient generally naturally grips when in pain.

When the trigger 60 is moved in the direction of the arrow, the valve means is moved (see Figure 4) to admit anesthetizing substance to 'the breathing tube and to the bag, and to close the air intake passage. When the trigger 60 is in the position shown in the drawings, the valve means is in the position shown in Figure 3, in which no gas can enter the chamber 35, nor the bag passage 39, and in which the air passage is open so that air may pass through chamber 35 into the passage 3? and into the breathing tube which, designated 65, controls passage 55, and

the other of which, 66, alternately controls bag passage 31- and the air intake passage .43, these valves being movable in unison. Spring 67 keeps .65 and/move the valve 66 from the valve element 66 against the bottom surface 68 out of the chamber to maintain a seal, the spring being carried in a tubular member which is pivoted to the casing 52 as at 69. Spring automatically moves the frame to the position shown to cause the valves to close the gas delivery and bag passages, and thegripping action of the patient is exerted against'the' action of this spring to move the frame to. open the valve its position over the air intake passage 36.

The

'. bottom.end of the tube is forked and engages to that shown by the arrows.

rection. It is obvious that when the'patient moves the element ,60 in the direction'of the arrow, the frame correspondingly moves, spring l2 acting to pull the tube to move the valve, which then moves to the position shown in Figures 4 and 5, in which position anesthetizing gas is delivered to the patientand air entry is prevented. Upon release of the grip and its movement to the position shown in Figure 1, the spring 10 acts to move the frame in a direction opposite Stop [it limits motion of valve 66 to a position over the air intake 36 or 43. Frame 41 is, of course, suitably slidably guided. After the valve 66 passes across I a vertical line passing through pivot 69, the valves are snapped to the position toward hich thev end of the tube 40.

are traveling. Spring 6|"|| acting inone direction, and springs 61-12 acting in the other direction.

Another feature of this invention is the means whereby the valve means can be locked in the position shown in Figures 4 and 5. This is accomplished by grasping the tube 50 and pulling in direction of the arrow. The result is that the tubular member 50 is pulled ofi of the extension 5|, whereafter it is made to assume the position shown in Figure 5 in which its end 16 abuttingly engages the outer end 18 of the extension 5|. This releasably locks the valve means in a position to close the air intake passage 43 and open the chamber 35 and the bag passage 39 to a supply of anesthetizing substance. Of course, the tube 56 could also be flexible, and could act as a conduit for conductors for the electrical operation of the valve means, by means of a button on the armof the dental or other chair.

When the control is used as an attachment for any machine which has a bag, the bag passage 39 may be closed by a suitable cap not shown. Referring to Figure 6, which shows .the attachment applied to the delivery passage of a machine of the bag type, the delivery passage is designated 80, the bag passage or tube 8|.. In this case, the tube 8| is closed by a cap 82, but when it is desired to attach the bag to the machine, the cap 82 is removed and the bag slipped over the tube, these parts generally having a friction fit. The cap 82 is'inte'rchangeable and is then placed over the Of course, in case of transfer of the bag from 40 to 8|, there will be no control of the bag opening by the patient-controlled valve means. The bag may, in some instances. be dispensed with.

.- Bil-pas Another feature relates to means by which gas from eitherf supply carboycan be directly introduced into the breathing tube, without pass ing through the main delivery passage 33. Th s feature is referred to herein as by-passing. Gas, either N20, or oxygen, or both, may be by-passed, andg'for this purpose, pipe connections are made with chamber 20 of each regulator, see Figures 1, '2 and 8, as at 85 leading by suitable pipes and connections, including unions and pipes 681 8B, to common passage 89 (Figure 3) ,vvhich, in turn, delivers into pipe 9il to which ."flexible breathing tube 9| is attached. Thi l t- Springs ii-I2 are each attached at one end 5 S a to theframe 41 and each at its opposite end is.: attached to'the tube containing spring 51.

ter tube delivers into flexible breathing tube 38 at a point relatively remote from the chamber 35 and valving means therein, and, therefore, remote .-from the bag opening 39 and air intake passage 35. Each pipe 88 has a valve 92. By this means,

" when desired, any amount of' gas may be delivered independently of any control by the patient and at the will of the anesthetist or operator. By this means also, either oxygen or ananesthetizing gas or vapor can be by-passed to the patient.

During by-passing, the by-pass valve for the anesthetizing gas is (when the patient is gripping) opened and gases are delivered'from two sources, to wit: a mixture of N20 and oxygen by the main valve and some extra N20 through th I by-pass.

It is noted that the point of delivery of'gas,

intake passage-or main delivery point.

A suitable safety valve is provided for each The valve of the bypass is generally adjusted to supply a lesser or greater quantity of gas than is normally delivered through the main valve or passage 33.

When the by-pass feature also lay-passed so that gas is shot directly and quickly to the patient without mixture in the bag. With the by-pass the patient cannot entirely out ofi the anesthetic gas. Although he can close the main supply valve from the machine to the chamber, the "by-pass continues to deliver to, or into, the inhaling tube. However, when he does close the main valve, he getsa mixture of air, as before, theonly result being that he cannot get as much air as he wishes, as in the construction of Figure 3.

Timing Another feature of the invention relates to meanswhereby the valve means can be independently controlled to continue delivery of anesthetizing substance for a timed period, after operation-of the valve means by the patient to stop delivery of such substance. This is necessary in some instances where the operator or doctor believesthat the patient is not capable of making proper judgment as to when the supply of anesthetizing substance should be stopped. One form of. device, for performing this function is best shown in Figure 9, which is a vertical longitudinal section. This device may be an attachment for any suitable machine, or may be an integral part of such-machine.

The rod 48 has a yoke 95 pivoted to a sleeve 96 slidable on a piston rod 91 having a piston head 98 operablein cylinder 99,. which cylinder is secured to the wall of the casing 52 within chamber by means of two pipe connections respectively indicated at I00 and IM and a fastening device or devices IOIas A spring I02 acts to move the piston to the position shown, against the gripping action of the patient, which gripping action moves the rod 91 in the direction of the arrows. The piston and cylinder constitute timing means.- When the piston is moved to the right from the position shown, as the result of gripping action of the patient, air enters the cylinder through check valve I03. When the patient releases the grip, the piston travels under the action of spring 92, against air pressure toward the left, and its speed is regulated by the exit of air past needle valve I05. By means of this valve, the timing period can be varied.

In order to release the rod 91 so that timing may be had independently of any control by the patient, the following means is provided: The rod 91 is notched as at I06 and this notch is engaged by a vertically slidable pawl I01 held yieldably in engagement with the notch by spring I08. At the top of the pawl is provided a cam I09 which can engage a trip pin IIO, the position of which can be, moved by rotation, by means of a set lever, to non-tripping position, When the stroke limit is reached during travel of the patient-controlled element'48 to the right, the cam I09 engages the.

trip H0 and the detent is disengaged from the notch I06 and the piston rod is released, to travel shownwhen the patient sufliciently releases the grip. The gripping action of the patient is against that of the spring 'I I2, as well as against the acaoeaecm tion of thespring I02. On tripping of the pawl, the patient continues to grip the control against the action of the spring II2, but as soon as the grip is released, the spring H2 acts to bring the collar to the initial position shown in Figure 9,

. Whereat the pawl assumes locking position. is used, the bag is of set screw III. Piston rod 91 and rod H6 move together. This rod forms part of the valve means and has a sealing fit in cylinder IIB, the inner diameter of which cylinder is greater than the outer diameter of the rod to provide a passage to receive delivered gas or vapor. The rod H6 is provided with a gas delivery passage II9 which opens into the chamber 35 at I20. The element II i has a foot portion I2I which abuttingly engages a valve I22 which is the functional equivalent of the valve 66 and alternately controls the passages 39 and 43. The valve I22 is pressed against the surface I23 of the casing 52 by means of a device generally designated I25 which is the functional equivalent of thedevice 6'l69 of Figure 3. The valve I 22 is moved to the position shown by action of spring I26.

During motion of the valve I22 in direction of the arrow or to the right by means of the foot IZI of the yoke I I4, and as the parts reach their limit of motion, a latch I21 engages a projection I28 of the valve to hold the valve over the air intake opening43 until the end of the timing period, that is during the time that the motion of the parts moves in a direction opposite the arrows or to the left. At the end of this period, a trip I29 engages a camming surface I30 of the is then moved to its initial position by means of the spring I26, to abut the foot I2I.

' The valving means may be modified to control only the passage 45 and the air intake passage 43, as previously mentioned in relation to the form of the invention shown in Figure 3. It will be understood that the intention herein is to cover control of either a two or three orifice valve means by the gripping on the part of the patient.

It is to be noted that the reciprocable valve bar H6 projects beyond the casing 52 whatever its position, so that the operator or doctorcan see it at all times. After the bar is moved to its extreme position to the right (main delivery valve open) and as the bar moves in the opposite direction during the timing period, the doctor can judge by the length of the projecting por-' tion of the bar, the stage of the timing period. It is further noted that by fully opening the valve I05, the timer can be rendered inoperative.-

During timing, breathing and rebreathing takes place in the bag, and is continuous throughout the timing period because valve I22 is released by latch I2'l only at the end of that time period. The important point is that the patient cannot breath air during this period becausevalve I22 is held in a position to close the air intake passage, and is released to close the bag opening only at the end of this period.

When the timer is used the speed of the pa.- tients recovering from analgesia is lessened and this timing is resorted to because the patient may be of a typewhq will not maintain the grip long enough to maintain analgesia over a period as long as the doctor thinks is necessary, and this scheme enables the doctor to deepen or continue pawl, to raise it and release the val e I22 which analgesia and, tnerefore, to obtain a finer or more accurate control of analgesia, conformably to the type of patient.

Means for increasing the amount of gas during timing period Another feature of the invention relates to means for increasing the amount of the delivered gas during the timing period, so that the patient will for the relatively short timing period, be made to breath more analgesic gas for this shorter period; or a greater volume of gas can be delivered, whether the timer is operative or not. To this end, a valve I43 controls passage I44, leading from the chamber H8 in communication with the gas delivery line 45, when the valve 65 is opened. A suitable hand lever I45 at the outside of the case controls this valve. An automatically controlled auxiliary valve I46 controls delivery of gas into the case 35 after passage through the valve I45. This latter valve I46 is attached to one arm I41 of a lever suitably pivoted as at I49 to the cylinder H8.

The opposite end of the lever passes loosel I5I raises the lever to close the valve I46. 010-. sure is initially prevented, however, by means of detent I53 pivoted within the slot I50 as at I54, said detent engaging a stop I56. During motion of the element II4 to the right from the position shown, the detent is moved away from the stop in the direction of the arrow to release the lever and obtain closure of valve I46, and rides upon the top of the lever and reaches the downwardly ofi-set portion I51. On return movement of the element H6, that is during the timing period, the detent I53 engages the stop and rides along the upper surface of the lever in a manner to open the valve I46 or move it to the initial position shown. An extra amount of gas is, therefore, delivered through the orifice I44 during the timing period and until valve 65 closes.

The timing mechanism is so constructed that timing can be controlled by the patient or can be controlled entirely independently of the pa- I tient, according to the position of the element H0. When the support carrying element is rotated so that IIO lies sufiiciently below the level shown, I09 does not engage it and no tripi0 ping takes place, but the elements 48 and 91 remain coupled. Automatic control independently of the patient is, of course, obtained as the result of the cam I09 engaging the trip I I0. The position of the trip is changed by rotating its sup- ;5 port by means of the lever shown in dotted lines.

The lever has a suitable handle and a translatable locking pin, not shown, which can be engaged with either one of two openings of the casmg.

intake passage to prevent loss of anesthetizing gas to the atmosphere, during a by-pass period, that is after the patient has released his grip to close the main valve. This device is illustrated in :5 Figure 1 and comprises cylindrical elements I60 and I M telescopically engaged so that the volume of the chamber can be changed, in this instance by sliding the lower cylindrical section I6I vertically relative to the element I60. The element 7 I60 has a removable friction fit with the tube. 42 and carries a rod I62, which rod slidably passes through a cross piece I63 carried at the top of the cylindrical element I6I. A head I64 on the rod limits downwardlmovement of the element 75 I6I. At the. bottom of the element I6I'there is through a slot I50 in the yoke H4 and a spring he removes the inhaler.

Means is providedandassociated with the air anair intake opening I66and above this opening, in spaced relation, is placed a guard I61. A valve plate I60 is arranged to control the opening I66, the plate being pivoted at I69 and having a handle. The volume is so adjusted as to catch only that volume which the operator judges the patient should breathe. This receptacle can be used with the timer, and by-pass features, and is useful for lessening waste of gas or gases.

After closure of the main gas supply the patient is breathing by-pass gas back and forth through the chamber, by means of passages 36I66. Under these conditions, part of the anesthetizing gas is trapped at each exhalation, and through this trap gas air is i i-breathed. As the result, of course, there is a mixture of air and gas in the chamber and in the breathing tube. If the chamber were not used, a substantially greater amount of anesthetizing gas would be lost to the atmosphere.

When using the by-pass; gas delivery continues after closure of the main delivery valve. With the timer, and also when the valve I46 is used, all gas is stopped after such timed closure. Of course, the by-pass feature may be used with the timing feature, and the machine can be used for anesthesia or analgesia. By-pass gas cannot be stopped by the patient or timer.

The regulator is set to deliver more than would normally be delivered from orifice I20 which orifice is smaller in caliber than passage II9.

When the device is used as an attachment shown in Figure 6, the by-pass pipes 86 are each provided with a union I40 which is adapted to be attached respectively to the oxygen and gas delivery pipes of any type of machine. The means by which the attachment is completed to the delivery pipe 80 is herein shown as a union nut I4I.

Another feature is that the cross-sectional area of the air intake is always equal to, and can be greater than, the corresponding area of the breathing tube so that the patient can substantially immediately get a supply of air. In most of the devices with which I am acquainted, the air intake or exit orifices are so small that free exhaling is not obtainable and the patient immediately senses this condition and is fearful that he cannot get' enough air, or cannot getit when he wants it. I

At present, indentistry, there is no means by which the patient can properly control analgesia, when a continuous flow machine is used, unless When an intermittent type of machine is used, the patient has to be told by the doctor to breathe through the mouth. The present invention controls analgesia without the adjustment of any parts or valves at the inhaler or mask, and control can be had entirely by the patients own effort.

In the present device no double tube connection to the inhaler is necessary, but only asingle tube of relatively large diameter. In operating the device, the patient does not grip any part of the inhaler tube. In fact, the hand which operates the device may rest onthe arm of the chair and is always well below the operating zone so that the patient cannot interfere in any way with the operation, as is likely when he has to raise his hands to the inhaler to adiust a valve.

Another advantage is that with the present device the patient will not -move the mask or Difierent persons react quite differently to the administration of an anesthetic and in addition, a proper state of analgesia is more diflicult to maintain in one person than another. Most persons are afraid to breathe such substances because of a feeling of suffocation and they always feel more secure when they believe they \have such a control as will enable them to get air when they want it. On the other hand, the patients judgment as to the quantity of analgesic substance required is not always sound and when this is so, the doctor or operator must be able to get control without letting the patient know that he no longer has full control. vention provides for all contingencies.

[It will-be noted that the orifice or tube fo attachment of the bag is placed between the point of delivery of the anesthetic substance into'the chamber, and the air intake opening and with. this arrangement, there is no'pressure on the bag or in the breathing line when delivery of the analgesic substance has been stopped by closure ofthe valve. Experiments have proven that pressure on the bag is not necessary, and some anesthetists do not desire that a quick on-rush of gas take place immediately that the valve is opened, because this on-rush is disconcerting to the patient. It will, of ,course, be understood that the gas bag can-be'placed on the machine at the opposite side or'entry side of the delivery orifice.

It will bejunderstood that the full hand gripping scheme is claimed broadly herein, whether the trigger grip be applied to a member which'can be swung and swiveled, or whether it be applied to the arms of a chair so that when the patient grips the arms (as he naturally does when in pain), the

trigger or buttonis moved to operate the valve to obtain delivery of more analgesic or anesthetic substance. Of course, the whole grip idea can be applied directly to a machine which is so placed that the patient can reach it when in the dental or other chair. plied on a bed, operating table, etc.

In regard to a connection such as 53, or its equivalent, which permits relatively extensive motion of the hand of the patient relative to the breathing line including tube and inhaler, there is no intention to limit the invention as to the exact location of the valve means. This flexible connection between the gripping piece or the hand-operable means could be on the tube or on the inhaler, but under such conditions, and with the present invention, the patient can move the arm relatively extensively, while maintaining the gripping control. In this device, the constricting action of the whole hand including the thumb is used, as distinguished from the pressing of a button or lever which is at the end of an element which, is gripped by the remaining fingers.

The words breathing line as used herein-are which the patient draws .anesthetizing gas or vapor or air or both, or oxygen, after such gas has been delivered from; the machine.

'Another feature of the invention is the idea of by-passing without patient control, or without the -use of valve means other than that necessary to the breathing line. Another feature is by-passdelivery through the delivery passage of the may chine. 1

The present in- Moreover, this idea can be ap- The timer can operate, in fact generally; does operate, while the patient is'tightly gripping the automatic-pistol-like grip, so that the patient is unaware that he no longer has control of the anesthetizing substance. On the other hand, if the trip HD is adjusted so that it will not be engaged,

by the element I09, timing can still be obtained if the patient releases the grip, and the timing period can be extended or lessened. When the trip Ill! is in position to trip, and. during timing, the patient releases the grip and tightens it again, an d re-starts the timer, thus extending the time. nutomatictiming only takes place when the trip is operative. When the trip is not in operative position, and as the patient releases his grip, the

various springs in Figure 9 act to move the elements 4%, 9i and H6 in direction opposite that shown by the arrows. Thus timing can be controlled by the patient, or independently ofthe patient. Moreover, timing can be used with or without by-passin'g, and by-passing can be used V to assume closed position. Nevertheless the valve 522, when it is used, is only allowed to snap to closed position when lit closes valve 65. In the form of Figure 3, both valves 65 and 66 are snapped 'to either open or closed position after the valve 66 passes a vertical line passing through pivot 69.

Although I have disclosed means for obtaining graduated rebreathing, see elements ltd, 56!, I68, Figure 1, it will be understood that a chamber the equivalentof that shown can be used, without the volume-variation feature. Another feature is the use of gas conserver so positioned that the air is drawn therethrough', but so related to the rebreathing bag that one only is used at a time, whatever the position of the bag. In case the bag is at that side of the delivery valve opposite that shown in Figure 3, then when valve .65 is opened, air passage 36 is closed, and the patient can breathe. in the bag, 'but not through the air opening, and when valve 65 is closed, passage 36 is opened to the patient, and bag is not open to the patient.

Another feature relates to the production of an anesthetizing machine including gauges 26, for indicating the relative volumes ofthe gases to be mixed, with means for separately delivering one or a number of such gases in a manner not to afiectlxthe gauges, including a valve which has graduat 'ons by which it ispossible to regulate the volume of this by-passed gas, relative-to the readings of the gaugesitojobtain a known volume or quantity'of by-passedgzis} 0 ases, or mixture of such gases. One .of thesejvalvesj' is showniat 92 in Figure-2, and its graduations are shown a t-a2 wheiithegauge hand is set at a certain position, the

amountof gas delivered by the direct valve is known measurable and variable. In this way, when analgesia or anesthesia; is being, c on-.

trolled by anesthetizing. substances from"I two source's, one of theqsubstances beingby-passed,

it isdesirable that the relativevplumes be known to the operator. r

I-"claimas my invention:

inhalation-- fluids, a breathing tube attached In'combination with a'machine. for deliverto the machine and having a mask, valve for controlling delivery of fluid from the machine into the tube, automatic means for closing said valve and means separate from the breathing tube and mask attached directly to the machine and adapted for swinging adjustment and having a movable element thereon operable only by a circumscribing or grasping action of the entire hand of a patient, to open said valve when rasping is completed, and operable when ing action ceases to permit instant closure of said valve by said automatic means to stop. delivery.v

2. In combination with a machine for delivering inhalation fluids, a casing providing a chamber into which the fluid is delivered from the machine, said chamber having an air inhaling and exhaling passage, and having a passage through which fluid delivery is made into the chamber, a breathing tube for the patient communicating with said chamber and having a mask applicable to the face of a patient, valve means associated with the chamber for controlling said passages to automatically close the delivery passage andopen the air passage when moved to one position, and to open the delivery passage and close the airpassage when moved to another position, and means operable by translation by a positive action of a patient to move'the valve means to open the delivery passage, and means by which said patient-operable means can be translated to aposition to releasablylock the valve means in a position to open the fluid delivery passage and close the air passage.

3. In combination with a machine for delivering inhalation fluids, an elongated breathing tube for the patient attached by one end to the machine, valve means at the machine and between the machine and the tube for controlling delivery of the fluid from the machine into the tube, and automatically operable to stop delivery, and elongated swingingly adjustable means directly connected by one end to and made a part of the machine and having at the opposite end a movable element thereon operable only by the grasping action of the whole hand of a patient for controlling said valve means for obtaining and maintaining deli-very of fluid.

4. In combination with a machine for delivering inhalation fluids, a breathing tube for the patient, a quickly self-closing valve controlling delivery of the fluid from the machine into the tube, means operable at the will of the patient by a sustained positive action for moving the valve to and holding it in open position and for allowing the valve to quickly close when such positive action ceases, and means whereby fluid can be delivered directly into said breathing tube forwardly of said valve in direction of the patient, independently of said patient-controlled valve means and operative position thereof.

5. In combination with an apparatus for delivering inhalation fluids, a breathing line into which the fluid is delivered from the machine, a

valve for controlling delivery of fluid into the 1 line, and means for automatically closing said valve? means for controlling said valve to retard theclosure thereof, means by which the valve can be controlled by a patient independently of or-in conjunction with. said retarding means, in-

eluding means by which the patient-controlled means'can act to open the valve and initiate a timing operation and thereafter allow the timing v 6. In combination with an apparatus for ad-' ministering inhalation fluids, a breathing line for for'controlling the delivery of fluid into the line, means for retarding valve closure, means operable by the patient to automatically couple with said valve means for opening the same and conciitioning the retarding means for retarding-action, and means for automatically uncoupling said means to initiate retarding action, said means being capable of recoupling during the retarding action.

'7. In combination with an apparatus for administering inhalation fluids,- a breathing line for the patient into which the fluids are delivered, 'a valve for, controlling the delivery of fluid to the line, and timing means for retarding valve closure to shut ofi the supply, means operable by the patient and capable of coupling and uncoupling with the timing means, and for coupling with the timing means to set the timer-and for releasing the timing means after setting, said means being capable of recoupling to re-set the timer during the timing period, and means by which the timer can be rendered inoperative so that the patient has full control of said valve means.

8. In combination with a machine for administering inhalation fluid, a casing providing a chamber having a passage connecting with a delivery passage of the machine, a breathing line connecting with the chamber, a valve for controlling delivery of fluid through the passage into the chamber, means for controlling said valve including a stiff tube and means connecting it to the casing for universal motion, an element translatable in the tube and connected to control the valve means, and an automatic pistol grip rigidly attached to the tube, and having alever pivoted thereto and attached to the translatable element, said lever being adapted to be encircled by a hand applied to the grip and to be moved as a result of grasping action of the hand.

9. In combination with an apparatus for administering inhalation fluids, including plural sources of fluid supply, means for mixing fluids from said plural sources, a passage into which the 'versa, means by which the patient controls said valve means, and a passage leading directly from one source of fluid supply and delivering into the breathing line forwardly of said valve means in direction of delivery to the patient.

. 10. In combination with an apparatus for delivering inhalation fluid including a source of fluid supply, a breathingline in connection with ,the source, a breathing bag in connection with the line, an inhaling and exhaling air port in connection-:with the line -[secondary re breathing chamber connected with the air port, for causing the patient to rebreath exhaled fluid mixed with air, and open to the atmosphere at a point remote from its connecting point, and valve means simultaneously'operable when moved in one direction to stop delivery of fluidtothe bag and'permit air entry to the line, and stop fluid delivery from the source to the 1ine, and when moved in the opposite direction to 'permlt fluid delivery. from the source tot-he line and bag, and prevent air entry.

11. In combination with an apparatus for administering inhalation fluid including a source of fluid supply, a breathing line into which the fluid is delivered from the source, an exhaling and inhaling air port connected with the line adjacent the source of fluid supply, and a re-breathing chamber connected with the port and open to the atmosphere at a point remote from its connecting point, and valve means simultaneously operable to stop delivery of fluid from the source to the line and open the air port, or to start fluid delivery and close the air port.

12. In combination with an apparatus for administering inhalation fluids including two passages through which the same fluid or different fluids can flow, a breathing line for the patient with which both passages are connected, a valve for each passage, means by which a patient can open one of the valves to obtain delivery of fluid from the corresponding passage into the line, and

means by which this valve is automatically closed 7 when the patient ceases to operate said means,

whereby two inhalation fluids can simultaneously flow to the breathing line and whereby the flow of one fluid can be started or stopped by a patient, while the other is flowing.

13. In combination with an apparatus for administering inhalation fluid, a breathing line for the patient, an automatically closing valve for controlling flow of fluid from the apparatus to the breathing line, manual means movable to a certain position by a positive action on the part of an operator to open the valve, means by which closure of the valve can be delayed for a predetermined time following such positive valve opening action by the operator, and means by whichthe valve can, accomplish its'delayed closure independently of said manual means, and while said manual means is in the position assumed to obtain opening of the valve.

14. In combination with an apparatus for administering inhalation fluid, a breathing line for the patient, an automatically closing valve for controlling flow of fluid from the apparatus to the breathing line, manual means operable from a point remote from the apparatus by a positive action on the part of a patient to open the valve,

means by which closure of the valve can be delayed for a predetermined time following positive while said positive valve-opening action by the patient on said manual'control means continues.

15. In combination with a machine for delivering inhalationflpids, a breathing line .forthe patient in operative connection with the machine,

, means for controlling delivery of fluid from the machine to the breathing .line including a valve and means for timing the valve to close and stop .fluid delivery, means operable by a positive action action to obtain valve closure, when positive action on'the part of the patient is completed following coupling action.

16. 'In combination with a machine for delivering inhalation fluid, a breathing line" for the patient in operative connection with'the machine,

means adjacent the. machinefor controlling demachf.ne, and

livery of fluid from the machine to the breathing line, including a valve and means for automatically moving it to close and stop delivery, means remote from the valve and operable by a positive action on the part of a patient for opening thea fluid inlet passage communicating with the de.

livery line of the machine and which, when open, is in free communication with the breathing line passage across the chamber, said casing having an air passage also in free communication with the breathing line across said chamber, valve means adapted to automatically close the inlet and open the air passage for inhaling and exhaling when moved in one direction, and when moved in the opposite direction to open the inlet and close the air passage to prevent inhalation of air and said means having a part which is swingingly connected with the casing said swingingly connected part having a part movable thereon and operable only as a result of continued grasping action of the Whole hand of a patient, without muscular action except that of the hand, to move the valve means to and hold the same in position to obtain delivery of the inhalation fluid to the breathing line passage, and so operable that when grasping action ceases the valve means is allowed to automatically move to stop fluid delivery by the machine, and open the inhaling and exhaling air port.

18. In combination with amachine for deliv ering inhalation fluids and having .a fluid delivery line, a casing providing a chamber, said casing being attached to said machine, said casing having a breathing line passage with which a breathing tube for. the patient communicates, and having a fluidinlet passage communicating with the delivery line of the machine, and further having an air passage as an inhaling and exhaling port, each of the last mentioned passages when openbeing in free communication with the breathing line passage across the chamber, valve means adapted to automatically close the inlet and open the air passage for inhaling and exhaling when moved in one direction, and when *moved in the opposite direction to open the inlet and close the air passage, to prevent inhalation of air and means including a part remote from the machine and valve, and operable by a positive and continued action on the part of a patient for moving the valve means to and holding the same positioned to obtain delivery 1 of inhalation fluid, and operable when such positive actionceases to allow automatic operation of the valve means to stop fluid delivery by the machine, said casing having a breathing -line' open the inhaling and exhaling air 1 passage with which a breathing tube for the 1 patient communicates, and havinga:fluidinlet tion, and when moved in the opposite direction' to open the inlet and bag passages, and close the air passage to prevent inhalation of air, and means operable by a positive and continued action on the part of a patient for moving the valve means to and holding the same positioned to obtain delivery of inhalation fluid, and operable when such positive action ceases to allow automatic operation of the valve means to stop fluid delivery by the machine, close the bag passage and open the inhaling and exhaling air port.

20. In combination with a machine for delivering inhalation fluids and having a fluid delivery line, a casing directly connected to the machine and providing a chamber, said casing having a breathing line passage with which a breathing tube for the patient communicates, and having a fluid inlet passage communicating with the delivery line of the machine and having a bag passage, and further having an air passage as an inhaling and exhaling port, each of the last mentioned passages when open being in free communication with the breathing line passage across the chamber, valve means adapted to automatically close the inlet and bag passage and open the air passage for inhaling and exhaling when moved in one directio and when moved in the opposite direction to open the inlet and bag passages and close' the air passage, and means operable by a positive action on the part of a patient for moving the valve means to and holding the same positioned to obtain delivery of inhalation fluid, whereby when such positive action ceases, the valve means 'is immediately automatically moved to stop fluid delivery by the machine, and close the bag passage and open the inhaling and exhaling air port.

21. In combination with a machine for delivery of inhalation fluid, including a casing providing a chamber, a breathing line for the patient operably connecting with the casing and chamber, means for controlling delivery of fluid from the machine to the breathing line including a translatable valve automatically movable to stop delivery, said casing having a tubular extension, a sleeve translatable upon said extension, means operable by a patient for controlling the valve, including an element attached to the sleeve, and an element which pases therethrough 'and through the sleeve and tubular extension and which isoperably associated with the valve, .the degree of translative motion of the valve in opening direction being sufiicient to permit the inner end of the sleeve to be engaged with the outer end of the tubular extension as a stop to lock the valve in open position, whereby by grasp- IliO ing the sleeve and pulling it, the valve can be latable valve automatically movable to stop delivery, said casing having a tubular extension, a

sleeve translatable upon said extension, a stiff tube, flexible tubular means, attaching one end of the stiif tube to the sleeve, an automatic pistol grip attached at an angle to the opposite end of the stifi tube, and having a lever-pivoted thereto to be encircled by the hand of a patient when grasping the pistol grip, a wire passing through all tubular elements and connecting said lever with the valve for translating the valve from its closed position to obtain fluid delivery, the degree of motion of the valve in opening direction being suflicient to permit the inner end of the sleeve to be engaged with the outer end of the tubular extension as a stop, to lock the valve in open position, whereby by pulling on the sleeve and translating it, the valve can be pulled to and locked in open position.

23. In combination with a machine for mixing and delivering inhalation fluids including a casing providing a chamber in operative connection with the fluid supply of the machine, a breathing line for the patient in communication with the chamber, a valve automatically movable to instantly stop fluid flow from the machine to the chamber, means operable by a positive action on the part of a patient to move the valve to obtain fluid flow, means for by-passing a fluid or fluids from the machine directly into the patient breathing line around said valve and remote therefrom, including a by-pass tube within the breathing line delivering axially in direction of fluid flow to the patient at a point forwardly of the valve, and tubular elements connected to said casing and delivering directly into said by-pass tube, and a valve for each tubular element for controlling and indicating the amount of the flow.

24. In combination with a machine for delivering inhalation fluids, a casing providing a chamber, a breathing line for the patient in operative connection with the chamber, means carried by the casing for controlling delivery of the fluid from the machine to the chamber including an automatically closing valve, a stiif tube, flexible tubular means attachingione end of the tube in operative relation with the casing, an automatic pistol grip attached at an angle to the opposite end of the stifi tube and including a lever pivoted thereto to be encircled by the hand of a patient as the pistol grip is grasped, and a wire passing through all tubular elements and connecting said lever with the valve for moving it to obtain delivery of fluid, when the lever is moved as a result of grasping action.

25. In combination with an apparatus for delivering inhalation fluids, a breathing line in operative relation with'the apparatus, a first valve for controlling flow of fluids from the apparatus to the breathing line, movable means controlling the'flrst valve, manually operable means for moving said movable means to valve-open position and thereafter permitting independent motion of said movable means to valve-closing position, means by which said movable means is moved in valve-closing direction at a governed speed, means by which non-anesthetic fluid can be introduced into the breathing line, a second valve controlling admission of such fluid to said Conducting means independently of said first valveand adapted to open automatically, means operable by said movable means when opening the first valve to close said second valve, means for releasably holding the second valve in closedposition during valve-closing motion of the movable means, and means by which the movable means releases the holding means during motion of the movable element to close the first valve,

which said element is moved at a governed speed to close the valve, means by which said movement of said element to close the valve can be independent of manually operable means to close the valve, means by which non-anesthetic gas can be conducted to the organs, valve means controlling admission of the non-anesthetic gas to said conducting means, means independently opening said last mentioned valve, means for releasably holding said valve in closed position so that it remains stationary during the movement of the movable element to stop delivery, said movable element being adapted to contact said holding means to release the same to permit said independent means to close it, movement of the movable means and the last mentioned valve being independent of the manually operated means.

27. In combination, a machine as the source of supply of a suitable inhalation fluid or fluids, and means to obtain a predetermined mixture of the fluids, a breathing line, a breathing bag, a casing providing a single chamber having passages communicating respectively with the source of supply of fluids after mixing, the bag, the breathing line,

' and the atmosphere, valve means automatically movable to a' position to close the supply and bag passages and open the atmospheric passage, means operable only by a prehensile or constrictive gripping action of the whole hand of a patient for moving the valve means to and holding it in a position to open the supply and bag pasdelayed closure of said valve means to close thefiuid supply passage including means operable by said patient-operable means ,to automatically couple with said timing means when gripping ceases, and thereafter on complete re-gripping to move the timing means to starting position, and

means for automatically uncoupling said coupling means after complete regripping to allow timing action, said means beingadjustable to prevent uncoupling action, and means for rendering the timer inoperative.

28. An apparatus for producing dental analgesia and preventing anesthesia comprising, a

machine supplying inhalation fluid, a mask for r the patient, a breathing, tube operably connecting said mask with the machine, quickly selfclosing valve means for controlling flow of inhalation fluid from the machine to the mask including a valve ,casing, patient-operable means for controlling said valve means including a tubular member attached to the valve casing and havingmeans adapted when squeezed by the patients hand to move said valve means to obtain and maintain fluid flow to the mask while squeezing continues, and to operate said valve means to stop flow when squeezing ceases, said tube being freely movable relatively to the casing to permit the hand-operable means to be freely moved and be placed in any convenient position to be continuously held, and so as to be held and operated without any muscular action other than required for moving the fingers, whereby the handoperable means can constantly remain in the hand, or can constantly rest by gravity in the palm, and whereby the entire arm can constantly assume a restful position, as in the lap or as on the arm of a chair.

29. In combination with an apparatus for administering inhalation fluids, means by which flow of fluid to the organs of respirationis controlled including a casing and a quickly self-closing valve therein, patient-operable means for controlling the valve to quickly open and close it including, a part adapted to be squeezed by the patients hand to open .the valve, and hold it open, and adapted to allow the valve to close when squeezing ceases and including a tubular operating connection between the hand-operable means and said casing of a character and of sufficient length to permit said hand-operable means to be swung and placed in any convenient position to be continuously held, and to be operated, all without any muscular action other than that required for moving the fingers.

30. In combination withan apparatus for administering inhalation fluid, means by which flow of fluid to the organs of respiration is controlled including a valve, manual means operable by the patient to open and hold the valve open,

and means by which the valve can accomplish its closure independently of said manual means and while said valve opening action by the patient on the manual control means continues.

31. In combination with arr-apparatus for administering inhalation fiuid, a breathing line for the patient, an automatically closing valve controlling fiow of fluid in the breathing line, manual means operable by a-positive action on the part of the patient to openand hold the valve open, and meansby which the valve can accomplish its closure-independently of said manual means and while said positive valve-opening action by the patient on the manual control means continues.

.1 32. In combination with an apparatus for ad ministerlng inhalation fluids, means by which flow of fluid to the organs of respiration is controlled including a valve, a, reciprocable control element for the valve, two springs operably connecting the control element with the valve and so arranged as to be alternately tensioned by the control element respectively to open and to close the valve, one spring to remain tensioned to hold the valve in the given position, one of the springs being de-tensloned when and while the other is tensioned, and a spring for separately moving the reciprocable control element in valve-closing direction. I 4

33. In combination antapparatus for administering inhalation fluids,- means by 'which flow ofdluid to the organs of respiration is controlledincluding a casing and a' valve therein, a reciprocable controlelement 'for the valve, two

springs operablyconnecting'the control element with the valveto be alternatelytensioned respectively to open and to close the valve, one spring to remain tensionedto hold the valve in the given position, one of the springs being de-tensioned when and while "the other is tensioned, a spring for separably moving the reciproca-ble control element in valve-closing direction, and means for operating the reciprocable control element, including a part adapted to be squeezed by the patients hand to put one of the springs under tension and open the valve, and to maintain the valve in open position while squeezing continues, and to allow the other spring to close the valve and hold it closed when squeezing ceases and a movable operating connection between the hand operable means and said casing of suin'cient length to permit said hand-operable means to be swung and placed in any convenient position to be continuously held, and to be operated, all without any muscular action other than that required for moving the fingers.

34. In combination with an apparatus for administering inhalation fluid, means by which flow of fluid to the organs of respiration is controlled including a casing having a quickly self-closing valve therein, means forcontrolling the valve to quickly open and close it, said means having a means operable by the patients hand, said valve controlling means including a tubular operating connection between the hand-operable means and the casing of a character to permit 1 said hand-operable means to be adjusted and trolled including a casing having a quickly selfclosing valve therein, means detachably securing the casing to said apparatus, means for control ling the valve to open and close it, said means having a means operable by the patientshand,

said valve controlling means including a swingable tubular operating element between the handoperable means and the casing of a character to permit said hand-operable means to be adjusted and placed in any convenient position relatively remote from the casing so as to be held and operated without any muscular action other than that required for moving the fingers whereby the entire-arm can constantly assume a restful relaxed position as in the lap or as on the arm of a chair, with the hand-operable means disposed for instant operation.

36. In combination with an apparatus for administering inhalation fluid, a breathing line for the patient, a casing having therein a quickly self-closing valve for controlling flow of fluid to the patient through said line, patient-operable means for controlling the valve including a part operable by the hand only of the patient without motion of the arm and therefore while the arm can constantly remain in a restful position, and an elongated tubular element through which control power is transmitted, said tubular element acting to connect said part with said valve casing and being adapted to allow said part to be swingingly adjusted to any position convenient to the patient.

anesthetizing machine comprising means for producing a mixture of anesthetizing WALTER R. HENION.

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