US 2606557 A
Description (OCR text may contain errors)
Aug. 12, 1952 M. E. STACK 2,606,557
MEANS FOR GIVING PERISTALTIC ENEMAS FIG.
3nventor Gttomegs MARY sTAcK Aug. 12, 1952 M. E. STACK 2,606,557
MEANS FOR GIVING PERISTALTIC ENEMAS Filed April 17, 1950 15 Sheets-Sheet 2 MARY E. STACK 72 Bnvcutor Aug. 12, 1952 M. E. STACK MEANS FOR GIVING PERISTALTIC ENEMAS 3 Sheets-Sheet 5 April 17, 1950 MARY E. STACK Zmventor ,water is released from the patient.
Patented Aug. 12, 1952 UNITED STATES PATENT OFFICE MEANS FOR GIVING PERISTALTIC ENEIVLAS Mary E. Stack, Seattle, Wash. Application April 17, 1950, Serial No. 156,305
4 Claims. 1
This invention consists of a method and the equipment necessary to practice the method of giving enemas through the use of the peristalsis of the bowels. In using this method, a flow of liquid with negative pressure is employed. The speed and volume of the flow is controlled to preclude the possibility of causing pressure on the colon, and full reliance is placed upon the reflexes and impulses of the patients bowel and colon, there being an accumulator to store and return said liquid during contraction andexpansion of the colon. i
This application is a continuation-in-part of my copending application, Serial No. 732,302, filed March 4, 1947, now Patent 2,538,215.
This method should not be confused with colon irrigation as it does not wash out the colon by forcing liquid into the colon under pressure, without regard to the impulses and reflexes of the elementary tract, and then depend upon the washing out of the colon when the impounded In distinction to this type of flushing, which has beenso long used to reduce constipation in the human bowel, this present type of enema contemplates introducing fluids, normally warm water, into the full length of the colon, thereby assisting nature and reducing the highly compacted material found in the colon to its more normal plastic form, so that it can be eliminated-by the patient in the normal manner after this method of treatment has been completed. Peristaltic action of the colon is stimulated during this process. To properly employ this method, mechanical means are provided for the introduction of warm liquid into the bowel, and, means are further provided for the control of the flow of such liquid so that the end result will be achieved without inconvenience or pain to the patient.
The enema, according to recorded history, has been used as early as 1618 for the relief of constipation in the human bowels. Since that time a great many types of syringes and various instruments have been devised in an effort to improve effectiveness of the en m e 110118 of these that have been observed have come into popular universal use with the exception of the ordinary enema-can technique, which has, for many years, been considered standard equipment in hospitals and other medical institutions, as well as in many homes. The operations of such equipment and the method followed usually takes the form of an attempt to Wash the feces from the colon by mechanical means, as a substitute for the abdominal reflexes provided bynature,
and results in more or less doubtful benefits and in distress to the patient. While the ordinary enema-can technique has served Very necessary and worthy purposes throughout the years, its operation and general results still leave a great deal to be desired, possibly because the efforts for improvement have not shown progress equal to the advance in other branches of medical science during the same period of time.
This present invention is believed to overcome many deficiencies experienced in the past and to provide at least one very practical solution of this perplexing problem. The enema given, following the teachings of this invention, is made to operate on the principle that the normal functioning of the alimentary tract should govern the injection of fluid into the rectum for the purpose of stimulating colonic muscular action, causing expulsive impulses. Further, mankind, by nature, is provided with abdominal reflexes and resulting expulsive impulses sufficient for the purpose of colonic expulsion, at regular intervals under normal conditions, and it has been reasonably proved that constipation is. an abnormal condition calling for correction. However, the principles of injection of fluid into the rectum by force is, at best, an unnatural act which violates the processes set up by nature for the normal evacuation of the waste of the bowels, especially when the colon is congested with feces and heavy internal gases.
In the usual case, the injection of fluid by force, may put pressure on and irritate an already extended bowel with resulting distress to the patient and possible failure to secure the desired results.
The principal object of this present invention therefore, is to provide a method and means for conducting peristaltic enemas.
A further object of this invention is to provide a method for the conducting of peristalic enemas in which the bowel may be considered, in effect, as though it were in series, with a source and accumulator of warm liquids which enter the colon without pressure and which stimulate nature to bring about the normal reflexes and impulses which may have reached a low functional level in the patients bowel and colon.
A further object of this invention is to provide suitable mechanical equipment so that the peristalic enema canbe given in a manner to promote and stimulate natures own .methods of evacuating the bowel.
A further object of thi invention is to provide mechanical means for supplying heated liquids at controllable near zero pressures and to provide the mechanical means for controlling the flow of such fluids, as medical experience has proved to be most desirable.
Further objects, advantages and capabilities will be apparent from the description and disclosure in the drawings, or may be comprehended or are inherent in the device.
In the drawings:
Figure l is a side elevation of the equipment used in practicing the method of this present invention;
Figure 2 is a side elevation, in section, with certain parts broken away, illustrating the internal construction of this equipment;
Figure 3 is a perspective view showing the electrical means used with this equipment;
Figure 4 is an enlarged longitudinal sectional view of the nozzle used with this equipment;
Figure 5 is a cross sectional view taken along the line 55 of Figure 2;
Figure 6 is a perspective view showing the upper elements of the equipment used in this invention;
Figure '7 is a bracketed diagrammatic view showing the valve setting when the equipment is positioned for the Off position, as shown in Figure 6;
Figure 8 is a bracketed diagrammatic view showing the valve setting when the handle is set at 1;
Figure 9 is a bracketed diagrammatic view showing the valve setting when the indicating handle is set at 2;
Figure 10 is a bracketed diagrammatic view showing the valve setting when the handle is turned to 3, as indicated in Figure 6.
Referring more particularly to the disclosure I in the'drawings, the numeral l2 designates the supply tank or source, and disposed adjacent it, is the return tank or accumulator l4. These tanks are normally disposed with their tops on the same level, so that a common yoke member It may adequately support the same, and in turn this yoke member may be adequately supported as from the opening l8, in lugs I9. It is to be noted that the bottom of tank 12 is somewhat above the bottom 2| of tank i l. Practice has indicated that the bottom 2! of tank l4 should be approximately one-third of the length of tank I2 below bottom 23 of tank l2. This relationship is necessary to insure flow oi fluid from the patient to tank l4 and prevent its flow from the patient to tank I2 when the reflexes of the colon cause such a return flow. This distance corresponds gen- I erally to the distance between the top and bottom of the colon area of a reclining patient.
Disposed below tanks l2 and I4 is the valve assembly, generally indicated at 24. The construction of these parts will probably be best understood by reference to Figure 2, in which it will be noted that athrough passage, or supply tube 28, operatively connects tank [2 and valve 24; and, likewise, a return tube 28 similarly connects tank l4 and valve 24. These connections further supply a means for joining the valve to the tanks as a useable connected unit, which in turn may be suitably supported, as by hook 311 from the U-shaped, or overhanging standard member, 32. This standard has a lower portion, as 34, which is straight and adapted for sliding into fitting 35, which joins together the supporting feet 38. An adjusted position for elevation is obtained byv meansof the locking lever 40.
seesaw Also, coupled to valve assembly 24 is the sup ply line 42 and the return line 43, both of these lines uniting in nozzle 45, vhich is shown in detail in Figure l. A fifth connection is made to valve 24 in that the waste line 46 is so connected to valve 24 that it can, by proper setting of the valve, discharge the waste from return can l4 into the waste tank 48. It will be noted, particularly in Figure 6, that collapsible bulbs 50 and El are provided, which in turn connect with the supply pipe 42, as at 52, and with the return pipe 43, as at 53. These bulbs, which are of the usual type in which when the finger is placed over the end and the bulb squeezed, makes it possible to force a small amount of liquid through either of the pipes so that stoppages usually caused by clots or solid materials in the form of lumps, may be dislodged by the momentarily increased pressure. Stoppage normally occurs at the intake and discharge openings formed in nozzle 45, when the same is in use.
Valve 24 consists essentially of a housing member 56, which is bored to accept the cylinder valve member 58. A hinged cover is provided for the cylinder at 60, and quick acting clamp means is indicated at 8!, so that the unit can be very readily taken apart for cleaning and sterilization after each use. The cylinder valve 58 is preferably a solid cylinder in which are bored a plurality of radially disposed passageways. As it is believed that the construction of such a cylinder valve is well within the scope of the experience of the average mechanic, the details of construction are merely indicated in diagrammatic form in Figures 7, 8, 9 and 10 where the two groups of holes, one at each end of the valve, are shown in the bracketed views. The setting in Figure '7 corresponds to the handle setting to the word 01?, in Figure 6. In this position all ports are closed. In the next setting shown in Figure 8, which would be 1 on the dial formed on cover a connection is made fromthe supply tank 12 to the supply tube 42, and then to the patient where discharge is made out through port 63 of nozzle 45. The return circuit is also completed so that return water or flu'id may be taken in the intake orifices 65 of nozzle 45, then flow through tube 43 through the cylinder valve into the return tank 14. Except for this complete circuit from tank l2 to the patient and return to tank l4, all other ports are'closed in the valve 24, in the setting shown in Figure 8. I
In the valve setting, wherein the operating handle 61 points to setting 2 on plate 60, and this conforms to Figure 9 of the drawings, a channel-is open from tank [2 to the patient through tube 42 and nozzle 45, and back from the patient through nozzle 45, tube 43, to the returntank (4. In this setting another port is opened that opens a channel from tank [4 through tubes 28 and 46 to the waste can 48, and also from the patient via tubes 43 and 45 to the waste can.- The liquid material in the colon may thus be drained while maintaining the flow of fresh liquid. All other ports are closed.
Figure 10 shows the valve setting for position 3 of Figure 6. In this case a constrictor, as
I 69, is placed in a passageway of normal size a'channelfrom the patient-via tube 43 and tube 46 to the waste can. All other ports are closed. This setting is usedin casesof dehydration; of
the feces where a very small're-supply is desirable. The setting at 3 is maintained until peristaltic action of the colon commences wherethe cylinder valve 58, the size of the orifice can bechanged to give a dripof varying amounts which can be suited to thepatients individual case.
The nozzle 45 used with this equipment is not, in efiect, a true nozzle as is normally considered wherein the elements are made of moulded hard rubber or some of the various plastics which are unyielding. In this instance, it has been found very desirable to provide nozzle 45 to be, in effect, two rubber tubes which are joined together, one alongside of the other, so the tubes, as a unit, can be readily inserted into the rectumor further into the colon than would be possible with the average separate nozzle arrangement which is so often used. To produce the nozzle, after the showing of'Figures 2, 4 and 5, we use material that has suflicient body so that it can be readily inserted into the colon and then possesses sufficient flexibility that it can be inserted further if desired- For this purpose, the supply tube 42 terminates in a tube of'reduced diameter which ismerged with the nozzle portion 13 of the return tube 43. 1
In Figure 5 a typical cross-sectional View is shown in which passage 12 will be observed to have approximately one-third of the diameter of passage 13, and this proportionhas been found to be very desirable. Passageway 12 may be small because the supply of liquid is not rapid and passageway 13 should be rather large to accommodate, with ease, the volume of material passing between the colon and return tank 14.
This cross-section should be continued for some length of the tube or nozzle, after the showing of Figures 2 and 4, so that insertion to the desired extent can be readily achieved. It is to be noted that the discharge of tube 12 is slightly back from the closed end 14 of tube 13, so that normally, the closed end 14 will serve as a guardand normally prevent the closure of opening 63 and at the same time it performs a function of a shield which tends to direct the outgoing'water or fluid in the line of prolongation of the nozzle. The intake ports 65, on the other hand, which communicate with tube 13, are spaced backwardly somewhat from end 14. This is in part to prevent clogging of the same, and further, to prevent a short circuiting of the fluid, which mightoccur if the how were conveniently possible from the discharge opening 53 to the intake openings 65.
Figure 3 illustrates an electric heating unit 80. This unit is supplied by electric current as through the cable 8 I, and is provided with side guide rails, as 82, which are adapted to co-act with the coacting guide rails 84, formed in the bottom of the supply tank l2. A spring loaded ball or detent is provided at 85 to hold the device in place while it is in use. This device can either be thermostatically controlled, or, it can be subject to operator control and the actual temperture taken by a thermometer placed in tank l2.
Referring to Figure 1, one form of operating table has been indicated generally at 81. This equipment, normally, is provided with vertical adjustments and tilting adjustments, so that the patient can be caused to assume the -most favorableposition for treatment. In Figure 1,
one of the most favorable positions of the patient is illustrated by dashed lines, 89, andnozzle is shown substantially in the position it; would occupy in the patient. Table 81is not partyof the peristaltic enema device.
Method of operation As the peristaltic enema is normally only properly given under hospital conditions, where either atrained nurse or a physician-is in attendance,
the method will be described and the use of the apparatus detailed, considering that the treatment-is being given under suchconditions. The patient is normally placed on his back and in such aposition-that the colon, as an entirety, is disposed substantially ina horizontal plane. This can be achieved by the normal positioning of the patient, as indicated in'Figure l, and is well known to skilled nurses. The enema tanks are then adjusted by means of the adjustablest'andard 34 so that the bottom of the supply vessel [2 is substantially on the mean level of the upper portion of the colon. This height insures gravity flow of liquid from the source of supply to the colon. This will place the return tank so that its bottom is somewhat below the level, as will be noted in the drawings, the difference in elevation of these two tanks is substantially the diameter of the average colon so that the bottom 7 of one tank will be at the top of the circular crosssection of the colon, while the bottom of the other tank will be substantially at the bottom of the cross-section of the colon. Valve 24 is set, after the showing of Figure 8, so that a free passageway is provided from the supply tank I2 to the patient through the small supply tubes 42 and "I2, and the larger return tubes 43 and T3 are connected also by valve 24 to the bottom of the return tank [4. Now, it is desirableto maintain this arrangement, namely, that the enema water or" other fluid supplied by the enema equipment enter the anus through the small tube 12, whereas the return is through the large tube 13. The arrangement of the nozzle 45; as shown in Figure 5, will illustrate the relative proportions sure, due to the insignificant head of water forv the fluid in the supply tank l2, there may be a short period where there will actually be no flow of fluid. This quite often occurs, due to the natural contraction of the anus and other muscular elements of the rectum and colon, but,'soon it will be noted that these muscles will become relaxed and the normal functioning of the body begins to take place. This gives the name to this -method, because it is the peristalsis of the bowel which causes the flow of liquid, an arrangement as shown and described where the liquid flows into the bowel by gravity with negative pressure and is only caused to circulate by the reflexes and impulses of the patients own bowel and colon muscles. This action is in marked contrast to the usual colon irrigation or enema in which water is introduced under pressure to actually attempt to wash out the feces from the bowel. This usual colon enema is contrary to all accepted principles of the natural functioning of the human anatomy and tothe invalid patient it is enema given to the patient so that normally only the sigmoid colon is affected. No attempt is made with this method to actually. remove any of the feces from the colon. The whole'function is to restore the compacted matter to the plastic condition Where normal evacuation can take place after the treatment has terminated, and to stimulate the peristaltic action of the colon. it is for this reason particularly that this form of enema is not habit forming in that it does not act contrawise to the normal functioning of the human anatomy, but, rather merely assists nature in doing its work. It is, of course, desirable to maintain a constant flow of clean liquid into the colon and for this reason it may be necessary to replenish the liquid in the supply vessel several times, so that several quarts of water maybe used in the entire operation. It therefore becomes desirable to have a discharge from the return vessel so that the desired supply of clean fluid can be continually supplied.
The two channels formed by tubes 42 and 43 are open at all times during the administration of the enema with all other channels, outlets, and inlets closed.
The double tubes forming nozzle 45 are so constructed and positioned, and the tanks l2 and M are so constructed and positioned as to insure the flow of a continuous stream of liquid through these two channels without interference, one with the other, except when interrupted by'the patients colon reflexes or gas pressure.
Double tubes of prior construction with one tube inside another, as with one channel protruding beyond the other, will not furnish this continuous flow in both directions without interference one with theother and interference of the in-flow with the out-flow has the effect of a boiling spring rather than a continuous stream.
With three pints of liquid in tank I2, with the channels open from tank [2 to the patient and from the patient to tank It, and all other ports closed and with the tube inserted in the rectum of the patient fora distance of four or six inches, he liquid star-ts flowing gently into the rectum.
if the colon should be completely empty. and if the-colon reflexes are such as not to reject the liquid, the liquid will then follow the colon through the sigmoid through ,the ascending transverse and descending colon down to the caecum.
However, when the bowel is constipated with usual accompanying gas pressure thecolon' will reject the liquid. at the sigmoid just beyond the rectum and therejection will cause the liquid to flow through the large channel of the double ended tube to tank M of the can, thereby releasing some of the pressure from the sigmoid reion after which the liquid in tank I 4 returns to the colon and the liquid continues to flow into the rectum from supply tank l2.
The pressureand reflexes may again reject the liquid to tank l4 several times in the descending colon before it reaches the splenic flexure causing it to ebb and flow between the rectum and tank [4 and this process will continue as the liquid travels, through. the transverse colon to the hepatic flexure-and through the ascending colon to the caecum when the pressure in the colon is exhausted and the patient has a complete peristaltic action with the urge which accompanies it.
The return tank I 4 or accumulator is, in effect, connected in series with the bowels of the patient so that liquid material from the colon may pass with ease into the accumulator during peristaltic contraction and pass from the accumulator to the colon during peristaltic expansion.
The valve is then turned to allow the Water to drain from the rectum, the tubes, and tanks l2 and M to the waste can. The tube is removed from the patient and he uses the stool or bed pan for a complete natural evacuation.
During the course of the enema operation it may be necessary to replenish the liquid in tank l2 from one to three times or a maximum use of four quarts of liquid.
Every facility is provided with this equipment, illustrated and described in this application to achieve these results; therefor it is believed that a truly new and very worthwhile treatment is provided in the teachings of this present application.
It is believed that it will be clearly apparent from the above description and the disclosure in the drawings that the invention comprehends a novel construction of a method and means for giving peristaltic enemas.
Having thus disclosed the invention, I claim:
1. Means for giving peristaltic enemas to a reclining patient, comprising: a liquid supply tank; means for heating liquid in said tank; a return tank; means for supporting said tanks with the base of the supply tank above the base of the return tank a distance approximately'equal to the distance between the top portion and bottom portion of the colon area of the body of a reclining patient, said means for supporting said tanks being adjustable vertically so that the base of the supply tank may be positioned at about the same level as the top portion of the colon area of the body of a reclinin patient; a valve assembly; a tube leading from the supply tank to the valve assembly and a tube leading from the return tank to the valve assembly; a supply line leading from said valve assembly and a return line leading to' said valve assembly; a Waste line leading from said valve assembly; said valve assenibly constructed to selectively control flow between said supply tank and said supply line and to selectively control flow among said return tank, said return line and said waste line; a resilient bulb connected to said supply line and a resili nt bulb connected to said return line for forcing liquid manually into said lines to increase pressure and clear clogging matter from said lines; and a nozzle for insertion into the colon of the patient, formed of a large tube connected with said return line and of a small tube connected with said supply line, said tubes joined side by side with the free end of the larger tube extending beyond the free end of the smaller tube, said larger tube having a closed end and an opening in its side spaced back from the end and said smaller tube havin an end opening.
2. Means for giving peristaltic enemas to a reclining patient, comprising: a liquid supply tank; means for heating liquid in said tank; a return tank; means for supporting said tanks with the base of the supply tank above the base of the return tank a distance approximately equal to the distance between the top portion and bottom portion of the colon area of the body of a reclining patient, said means for supporting said tanks being adjustable vertically so that the base of the supply tank may be positioned at about the same level as the top portion of the colon area of the body of a reclining patient; a nozzle to be inserted in the colon of the patient, having two passageways side by side; a supply line leading from said liquid supply tank to one passageway; and a return line leading from the other passageway to said return tank.
3. Means for giving peristaltic enemas to a reclining patient, comprising: a liquid supply tank positioned with the level of liquid therein above the level of the top of the colon area of the patients body; a return tank positioned with its base below the level of the top of the colon area of the patients body; a nozzle to be inserted in the colon of the patient, having a large passageway and a small passageway side by side; a supply line leading from said liquid supply tank to one end of said small passageway; a return line leading from the adjacent end of said large passageway to said return tank; and said nozzle having a closed end beyond said large passageway and having a side opening into said large passageway spaced from the end of said nozzle, said nozzle having an opening at the end of said small passageway, the end of said small passageway being spaced back from said closed end of said large passageway.
4. Means for giving peristaltic enemas to a reclining patient, comprising: a liquid supply tank; means for heating liquid in said tank; a return tank; means for adjustably positionin said tanks vertically as a unit, in relation to the patients body; a valve assembly having an internal cylsageways; a supply line leading from said valve 4 assembly in the area of the valve passageways associated with said supply tank; a connecting tube from said return tank to said valve assembly in the area of the associated valve passageways; a return line leading to said valve assembly in the area of the valve passageways associated with said return tank; a waste line leading from said valve assembly in the area of the valve passageways associated with said return tank; a nozzle to be inserted in the colon of the patient having separate passageways connected with said supply line and said return line; means for rotating said internal cylinder to control the passage of liquid in the system, said internal cylinder having no passageways at one position in which liquid can pass to and from said tanks, having passageways at a second position in which liquid is free to pass between said supply tank and said supply line and in which liquid is free to pass between said return tank and said return line, having passageways at a third position in which liquid is free to pass between said supply tank and said supply line and in which liquid is free to pass among said return tank, said return line and said waste line; and a fourth position in which liquid is free to pass between said supply tank and said supply line and in which liquid is free to pass between said return line and said waste line; and a removable constriction bushing insertable in the passageway between said supply tank and said supply line in said fourth position to vary the area of said passageway free to the passage of liquids.
MARY E. STACK.
REFERENCES CITED The following references are of record in the file of this patent:
UNITED STATES PATENTS Number Name Date 580,674 Wertz Apr. 13, 1897 2,148,541 Dierker Feb. 28, 1939 FOREIGN PATENTS Number Country Date 509,896 Great Britain July 21, 1939