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DBC- 25, 1944- I F. c. HOUGH-TEN ETAL 2,366,030 METHOD OF AND MEANS FOR INDUCING- ARTIFICIAL FEVERS Filed Aug. 5, 1940 I . ‘ 11 _ . I 2 Sheets-Sheet 1 ,,. 3v i241. | ' (14‘ I i 1 24 I . “ ' ' ~ @688 E.' " )1 /7 l Fm". 1‘ 1133i 36 a?1' Y5 L15 2? lg".3. _ .552, ¢.#°;}2Z;“T°F? q?nzmm/ Eff/cr Dec-~26, 1944- F. c. HOUGHTEN ET AL‘ 2,365,030 METHOD OF. AND MEANS FOR INDUCING ARTIFICIAL FEVERS . Filed Aug. 5, 1940' 2 Sheets—Sheet ' 2‘ N VEN TO R Patented‘ Dec. 26, 1944 2,366,030 UNITED‘ ‘STATES, PATENroFHcE ‘- METHOD OF AND MEANS FOR INDUCING ' ARTIFICIAL FEVER Ferry C‘. Houghten and Murray B. Ferderber, ‘ Pittsburgh, Pa. ‘ , Application August 5,1940, SerialNo'.351,¢l56 2 Claims. ((31.128-373) ' Our invention relates to a method of and an and the method of operation and‘the apparatus apparatus for applying fever therapy to individual portions of a human body by conditioned air. In our application, Serial No. 162,626, ?led Septem described herein have been developed to permit _the local application of fever therapy treatments without affecting the healthy or normal portions 1 of the body. ' ‘ We have found, for example, that certain‘ail ber 7, 1937, we disclosed a method of and an‘ ap paratus for inducing arti?cial fever generally in the human body. ' ments affecting an extremity such as an arm or a ’ Heat has been used ‘therapeutically in many forms for hundreds of years, including such modalities as packs,‘ steam .baths, electrical ap plications, such as ‘short wave, diathermy, etc. Any or all forms are used to produce the same effect, i. e., increased circulation of the part in; volved. Some‘ means are considerably safer than others, combining simplicity, ?exibility, and con trol of conditions. \ r , I-Iyperpyrexia (fever therapy, 'hyperthermia, etc.) has become ‘an accepted form of treatment that has been employed quite successfully where its uses are indicated. However, there are numer leg could be bene?cially treated by thelapplica tion of moist heat to that affected part, or by the application of such heat to an unaffected part, such as a normal ‘arm or leg‘, inorder to establish re?ex heat action in the arm or leg to‘be treated. ‘ We have also found that certain back ailments 15 have responded most satisfactorily to local ap plications of moistheat, according to the present ‘process. ' i The present apparatus in one form consists sub stantially of a‘ cylinder three or four feet long, and about ?fteen or sixteen inches internal di 20 ameter, with‘ one end of the ‘cylinder open to re ous patients who require some form ‘of heat ‘therapy-but who object to general treatment where only one extremity vmay be involved. Then, too, there are patients who have reached the age or who are‘ prematurely physically unsuited for ceive an arm or leg, after which that end of the cylinder is closed by a soft rubber curtain, tucked around the‘ arm or leg. At the closed end of- the general therapy“ These patients require treat spray is arranged to establish‘ an air stream and circulate the air within the cylinder while humidi fying it at the temperature desired.‘ The spray ment of the localpart-to relieve them of their symptoms, which are frequently quite severe. cylinder, is disposed an air-conditioning unit con sisting of an'air circulating duct in which a water Physiologically, heat produces dilation of blood head may be supplied from the ordinary hot and Vessels which in turn increases the circulating 30 cold water systems in any building, or from any volume of the part involved. Capillaries which auxiliary water circulating device. are, normally very small became engorged with ‘ Evidence from work done with apparatus of this blood, the elements of which are instrumental in type has de?nitely shown that water saturated producing relief of symptoms and in many cases atmosphere will produce the desired increase in complete resolution of the pathological processes, 35 temperature in the body, and is therefore par ticularly desirable because the danger of burns to Because of the stimulated circulation, the affected area receives blood supply capable of handling the the skin of a patient is greatly lessened on ac metabolic processes and relieving symptoms which count of the low dry bulb ‘temperatures. frequently are severe and are caused by the ac cumulation of metabolites.’ The apparatus disclosed in our previous ap plication consists generally of a box large enough to receive and accommodate the entire body of the, patient from the neck down- The head of the‘ For example, inmost industrial hospitals the 40 whirlpool and‘foot baths‘ are used for soaking and heating an‘injurecl extremity. The tempera ture of these baths usually ranges from 108 to 120° F., and mostfrequently the-lower range is used because discomfort becomes too great at the patient extended out from the box, while the 45 high temperatures. Since this apparatus uses body of the patient was subjected to a circulating humidi?ed air and since theheat transfer from. stream atmosphere of water saturated air. ‘ That large apparatus was employed‘where gen the air to the body surface is not as great the air temperatures may be‘ carried to a higher range eral fever therapy treatment was necessary. without any discomfort and de?nitely without We have found certain conditions and ailments 50 danger of burning. To verify this, one extremity was placed within the‘apparatus enclosure and of the body, however, for which it was not neces sarily desirable ‘,to‘ apply general fever therapy.v the other in a water bath and the temperatures of both raised simultaneously. When a tempera However, the application of localized “fever therapy ‘solely to an affected portion of the body‘ ture between 112 to 115° F. was‘ reached, the foot has brought about unexpectedly bene?cial results, 55 was ‘withdrawn from the water bath because of .2 g I 2,366,030 aspirator to draw air from the space or come partment I2a within the shell l2, and to force apparatus remained and no complaints of dis that air in and around through the conduit I9 comfort were elicited. and back into the compartment I2a through the In another form of‘ apparatus, a semi-circular upper or outlet end 24 of the, conduit. shell is used where a part of the back is to be The inlet end 23 is preferably disposed on a treated with moist heat. In this structure, rubber lower plane than the outlet end 24 in order to curtains are also provided to con?ne the space take advantage of the natural strati?cation of within the shell to the portion of the body to be the heated and moistened air as it is supplied to treated; and a similar spray device is employed to circulate, moisten, and heat the air within the 10 the treating chamber I2a. During the circula tion of the air, as the air is heated and moistened enclosing shell to create the circulating stream of -1 by thelwater spray, and then supplied to the saturated air at the desired temperature. compartment I2a, that heated air tends to spread The apparatus and the method of operation to establish the desired treatment of the selected ' or stratify over the upper space in the compart portions of the body of the patient are shown in 1'5' ment I2a. The temperature drop or gradient discomfort, but the leg treated in the described - -_ Within the compartment between the top of the the accompanying drawings, in which ' Figure 1 is an end elevational view of a unit- > ‘compartment and the bottom of the compart for treating the back part of the body of a pa tient, and consisting of an arch-shaped cover to ?t over the back of the patient, with a principal vment is relatively small. However, as the warm, moist air comes into 20 contact ‘with the portion of the body being treated, the moisture in the air condenses on that portion of the body, and a corresponding amount of heat that was stored in the air is de temperature; livered to the body, and the temperature of the Figure 2 is an end elevational view of therap- ' is correspondingly reduced. This cooler air paratus in Figure 1; 25. air thereupon drops toya lower level in the com Figure 3 is a plan view of the apparatus in partment. That cooler air is then drawn back Figure 1; up into the conduit, in which it is ire-conditioned Figure 4 is a side elevational viewof an ap by the water spray, and then forced through the paratus for accommodating and treating an arm or a leg; . 30 conduit by the same water spray to re-circulate through the compartment in the shell. The re Figure 5 is an elevational view of the control verse travel of the moistened and warmed air unit that is mounted at the end of the appa through the rising portion I9a of the conduit ratus in Figure 4; ‘ serves to remove any excess moisture that might Figure 6 is a side elevational view of an ap otherwise be carried in the circulating air stream. paratus similar to that in Figure 4, except that Such excess moisture and the part of the water it is provided with a control unit of a different spray that has not been absorbed by the air type; stream pass out of the conduit at the bottom Figure 7 is an end elevational view of the air through the drain 22. conditioning or control unit at the. end of the ap The water spray head I8 may be supplied with paratus in Figure 6; and Figure 8 is an elevational view at the open end ' water of any desired necessary temperature by suitably controlling the the valves 26 and 2'! re of the apparatus in Figure 6, showing the open spectively connected in hot and cold water cir ing in the curtain through whichthe arm or the cuits that are connected to supply water to the leg of the patient extends during treatment. ’ 1 The apparatus I0 shown in Figure 1 comprises, .45 spray head l8. In order to determine the temperature of the brie?y, a rubber mat or mattress II upon which “ unit mounted on the side of the cover to supply a circulating stream of moist air at the desired conditioned air stream,‘ an opening 28 is provided at the top of the shell I2, to permit a thermom eter to be extended therethrough into the com partment I 2a. the mattress I I, to con?ne the moist treating air The foregoing unit with the shell I2 may, of to that portion of. the body‘that isv to be treated. course, be applied to any portion of the body to The open ends of the cover I2 are provided with be treated, but is primarily intended to treat suitable closures such as rubber curtains I3 and different parts of the back of the body of the I4 that con?ne the moist air to the volumetric space contained in the part of the cover‘ over the 55 patient, from the shoulders down to and includ ing the hips. ' body that is to be treated. Upon one side wall The apparatus shown in Figures 4 and 5 is in I6 of the cover or shell I2 is mounted a bracket tended primarily for use in treating an arm or a or frame I5 that is integrally secured to the side leg. This unit 30 comprises in general a box 3I wall I6 of the cover to serve as a support for a plate I‘! upon which is mounted a water spray. 59 having a cylindrical inner space or compartment 32, with a rubber closure 33 at one end of the head I 8 and a cooperating conduit I9. _ boxand with a closing plate 34 entirely closing The side wall I6 of the unit I2 is provided with the other end of the box. The rubber closure 33 a large opening 2| which is entirely surrounded is provided with an opening through which an by the ‘bracket frame I5, so that the space or arm or leg of the patient may extend to be dis compartment within the shell I2 will communi posed inside of the operating chamber 32 of cate with the space within the frame I5, and so the ‘box. ' that the air in the shell I2 can be conditioned or Within the operating chamber is disposed a moistened, heated, and circulated by the action rubber mat or platform 35 to‘ support the arm or of the water spray dropping from the head i8 down into the conduit I9. A suitable drain 22 19. leg that is to be treated. At the closed end of the box, the end wall 34 carries off all excess water from the spray, and consists of a plate which is ‘arranged to be suit all water in excess of enough to saturate th cir ably anchored by bolts 36 around the peripheral culated air stream. edge to a suitable ?ange or peripheral section of As the water spray drops down vertically into . the inlet end 2~3~of the conduit I9, it serves as, an a the box 3|. the patient’s body is to rest during treatment, and an arch-shaped cover I2 to ?t over the por tion of the body to be treated and to rest upon 3 2,3 66,030 proper ‘manner in" the air conditioning unit ‘from * vThe end wall plate 34 serves as‘a‘support for a water pipe 31 extending through the plate 34 to the inlet opening 51 to the outlet or supply open a permit its outer'end to be connected to a suitable ing 58, the space in the shallow shell 53 is di vided‘ substantially into three compartments 6|, source of water supply, whose temperature may be suitably ‘controlled to be ‘of the‘ temperature of the ?nal mixture to be supplied to the inlet pipe 31. , . ‘ ‘ -62,‘and B3. ‘The lower endlof the compartment 6| termi nates substantially in the inlet opening 51 through which the air is drawn from the lower levels of the main compartment of the box, The upper - The inner end of the pipe 31 supports a water spray head 43 that is disposed over the inlet open ing 44 of a conduit 45. "10 end of the compartment 6| leads to the upper The conduit 45 is of substantially J shape,vwith the spray from the spray‘ head 43 dropping into theinlet opening 44 of the conduit and ‘serving .end of‘ the middle compartment 62, so that the ‘_ operation of the spray will draw the air upward from the inlet'opening 51 through the compart ment 6|, and then force it downward through the the conduit 45. The air thus drawn into the con 15 compartment 62, and thence into and upward through the compartment 63 to the outlet open duit is heated or cooled, according to the‘ tem ing 58. Two spacers or ba?ies 65 ‘and 66 are dis perature of the water, and is then propelled on posed adjacent to the spray head to establish ward through the conduit 45. The other ‘arm the intermediate space in the middle compart 46 of ‘the conduit rises vertically to an outlet opening 41 that is disposed at a higher level than 20 ment 62, within which the spray from the spray head is to be con?ned. The outer surfaces of the the inlet opening 44. i as an aspirator to draw the air from the'box into - ba?ies .65 and 66 are rounded substantially to the curvature of the wall of the shell 53. The lower end of the baiile 65 is provided with a tail piece propelled air is caused to move downward under 25 65a that is disposed along the peripheral edge of the inlet opening 51, and out to the inner surface ' the spray and back upward through the section of the wall of the shell 53. 46 of the conduit, and out through the outlet The upper edge of the ba?ie 66 ‘is similarly pro opening 41 into the space of the compartment 32 The downward movement of the water spray from the spray head43 moistens, heats, or cools, and propels the air as already mentioned.’ The in the box 3| . vided ‘with a tail piece 66a that extends out to the In the form of control conduit shown in Figures 4 and 5, the outlet opening 41 may be reduced in diameter to provide a constricted throat at the outlet, in order to impart an increased velocity to the travelling air supply where it leaves the conduit, if the treating box 3| is unusually long. ' wall of the shell 53, and substantially along the edge of the outlet opening 58. These two tail .pieces insure that the'air circulation will proceed along the desired path from the inlet opening 51 up through‘ the compartment 6| and down through the compartment 62, where the air will be moistened and heated, or cooled, by the water spray, and then forced by ‘that spray upward through the compartment 63 and out through the outlet opening 58 into the main or working cham Ordinarily, the heated, saturated air,‘ when pro jected from the outlet end of the conduit, will tend ' to stratify or distribute itself at the upper levels of the box. When air is withdrawnto the inlet opening 44 by the spray, the air at the upper levelswill drop and will assure movement of the saturated air throughout the entire space of the box in which the arm or leg to be treated is dis. ber of the box 5| . > t The location of the inlet opening 51 is such as to be substantially in the region of the lower most portion of the main compartment in the box. posed. The outlet opening 58 leading to the box is lo A drain .48 at the bottom of ‘the box removes all 45 cated practically along the upper region of the ‘main compartment of the box, so that the mois of the condensation that accumulates in the box tened and heated air will tend to stratify in hori 3|, and removes also ‘the excess water from the zontal planes‘throughout the length of the main sprayhead 44 that drops ‘down tothe drain 48, chamber of thebox 5|. As the air is withdrawn through an opening 49 at the bottom of the con duit. ‘ In Figures 6; 7, and 8, we have illustrated a local treating unit 50 in which the box 5| itself is similar to that shown in Figure 4, but the air conditioning unit 52 is somewhat different in con _ struction. 50 from the lower‘ regions of the box during the op— eration of the water spray, the entire volume of air in the box tends to move downward as a blanket upon the arm or leg that is‘disposed in the‘box,>to‘be treated by the hot moist air. 55 In each of the forms shown herein and in _ It is arranged to be applied to or disconnected ' tended for local applications, the air condition ing system is of the general dew-point type, in from the end of a box 5|. The air conditioning ' unit 52 is shown as consisting of a shallow recessed which the highly atomized water spray at the circular shell 53, provided with ,a straightened upper end of a small duct supplies both the mo peripheral ?ange 54; by means of which the shell 53 may be secured to‘ the end of the box 5| through tive power for circulating the air and the heat and moisture for saturating the air at the desired the medium of anchoring bolts or screws 55.. In order to control the air movement in a predeter spray gives the air a momentum that removes it temperature. The downward movement ‘of the from‘ the lower- portion of the box and delivers it in saturated. condition at the desired elevated temperature to the top of the working chamber is provided with‘two diametrically ‘spacedopen of the box. By reason of the stratification of the ings 51 and 58, disposed substantially as indicated in Figure '1. . ‘ ' saturated heated air as it is supplied to the work-v ing chamber, there is little or no temperature In order to moisten, and to heat and move the stream of air, as ‘in the other modi?cations, a 70 gradient throughout a horizontal cross-section, spray head 59 is supported on the shell 53, with with a minimum controlled gradient from the top mined path, a perforated plate 56 is disposed be tween the shell 53 and the box 5| . The plate 56 the connecting pipe 60 extending back through the back of the shell for connection to a suitable source of water supply. to the bottom of the chamber. ' ' ‘ With a forty pound water pressure and a four . inch duct throughout the air conditioning system, _In order to control :the air movement in the 75 9.8 cubic feet of air per minute are removed from 4 2,366,030 the-bottom of the ibox,--iheated .and‘saturated to more ‘beneficial than short ones. ‘.Theibodymust the desired temperature, and returned to, .the upper portion. Without insulation twenty-1 .to thirty gallons of water per-hour are su?icient for satisfactory conditions in the box, andif‘ the cyl inder is insulated to insure-againstexcessive heat loss to the surrounding atmosphere-a consider ably smaller water volumeqwill ,suf?ce. _A water temperature of 130° F. will ‘produce a uniform saturated atmosphere of from 120° to 125° vF. Since the air is saturated :upon? entering the box. and loses heat before being [returned to the air conditioning part of'the cycle,:saturation is'in have time'to-adjustitselfto.any'change, and sud= den forms of treatment, short-lived, are not 'as bene?cial. This? apparatus can be used'for-two to three or more hours without danger. In view of the gradual'dilatation, the bloodpres sure in the body is substantially unchanged, ‘and the pulse rise, if any, is negligible. At the same time, an increased rate 'of blood ?ow is estab lished within the treated region or extremity. .Such, increased local ‘circulation in the part of the body that is treated is established withlittle or no increase in thegeneral circulation, which sured throughout. ‘ would cause an extra load on the heart, which From a comparative standpoint the whirlpool .15 might be unable to standthat extra load. With baths using rapidly'agitated‘water from 108° 'to the present apparatus and the method‘of treat 120° F. have been used in. industrial‘ hospitals to , ment involved, it is, therefore, possible to treat an produce a hyperemia (increased blood supply)‘. arm orv leg of ‘a person whose heart would not The upper range of temperature. in. this water permit the application of general uncontrollable bath is apparently too great .‘for comfort and 20 heat therapy. ' could conceivably cause certain di?iculties‘which By means of the present equipment, it is pos might arise in a patient with.impairedrcirculation sible also to control the ratio of the area of the in the extremities. The abilityof a patient 1-to surface to which the heat is applied tothe-area tolerate temperatures between 114° and 120° F., of the untreated surfaces,'which serve as heat saturated, is outstanding sincemost‘of the cases 25 dissipating areas. ‘ ' are treated at these temperatures without danger The important feature of the present apparatus of complications. From experience it‘has :been iszthe- fact that it'provides a tolerable'heat which I found that it is necessary'to treat a pateint one the patient can tolerate for a substantial period to three hours to producedesired'effects; and-the of time, running continuously into hours, with index of improvement increases with each suc ceeding treatment. Usually a course of treat ments would consist of thirty-‘sixihours at a pre '30 determined temperature usually divided into twelve treatments of'three-hoursleach given daily or every other day. Theincrease in pulse rate 35 out anydeleterious effects. The long-continuous treatment is, of course, ‘advantageous since it rovides the greatest healing eifect by enabling the system to remove the products of the ailment over the extended period of continuous treatment. With this apparatus there'is no burning, either of the-skin or internal parts of the body. There count would average about .1500-‘cells, which may is no shock due to sudden application of heat be purely a personal variation "in making the energy in. alform that compels the body to absorb counts. The rise- in body temperature resulting it more suddenly than thebody can adjust itself from this treatment is insigni?cant and varies 40 to absorbthat ‘amount of heat energy. The bene from no rise to a maximum rise of from 1° to 11/2" ?cial action in the increased dilatation locally is F. This increase doesnot a?ect even‘ those 1pa not attended by any overloading on a heart that tients su?’ering from severecardiac lesions. is unable to tolerate-the more than normal-func In comparative tests'ofiheat applications by tion. . short wave, by infra-red'rays, andv by saturated In our experience vwith the present equip~ is fairly insigni?cant, andthe rise' in leucocyte air at slightly elevatedtemperatures ‘according to the method described‘herein and by means-of the present local apparatus, it‘was vfound that the most rapid temperature increases occurred using short-wave,»and the deepitemperature'was ele vated as high as 108°-109° F. 'When the‘ short wave generator was disconnected‘, the deepitem perature dropped immediately, and it reached'its normal within twenty=minutes. ‘Using infra-red heat the vdeep temperature response was not so " rapid nor was the temperature rise as great; and removal of the heat sourceprecipitated a rapid fall of the deep temperature. iMoist‘heat pro ment, weihave employed saturated atmospheres throughout, and‘have found that fully saturated atmospheres have provided optimum conditions, since-lower dry bulb temperatures could be em ployed. In order, however, to be able to control the per centage of moisture containedin case less than vcomplete saturation might be desired, we may dispose a heating element 10 just ahead of the outlet end of the air conditioning conduit, as shown, for example, in Figure '7. This heating element 70 may be utilized if desired, and heat from an external circuit through conductors ‘H rise, not quite as high as short-wave, but even 00 to superheat the saturated airstream, and there by reduce the relative moisture contained to a when the heat source ' was removed and' cold value below complete saturation, water circulated through the apparatus at a tem ‘Our inventionisnot necessarily limited'to the perature of-GO" F., the deeptemperature per speci?c details of construction that are shown, sisted for one-half hour before it‘ started to drop; since these may be variously modi?ed without and it was back to its previous normalin an departing from the spirit andscope of the inven hour. Thesigni?cance of this comparison is quite important in view of the factxthat moist ‘heat tion, asset forth in the appended claims. ‘We claim as our invention: treatments are given for two ‘or three hours-with out producing pain or burns. ' -1..An apparatus for- applying moist‘. heat to a ‘For example, dilatation occurs-slowly but pro 70 localizedarea of‘ a. human body, comprising an gressively, down tothesmallest capillaries; Since enclosure to ?t over the portion‘of the body to this is not sudden (as inshort-wave), fatigue of betreated and providing a relatively‘free main the nervousmechanism controlling the dilatation space compartment ‘within the enclosure; and or constriction does not occur. Therefore, we can means for circulating a stream of saturated air duced a considerably slower deep temperature give long. periods .oftreatments?which-are always 75 through‘ the. compartmentrsaid- means compris 2,366,030 ing a conduit communicating with the main com partment, of J-shape, a water-spray head dis posed at one end of the J-conduit vertically, and ' 5 body; a soft rubber curtain at both ends of the cover to close the compartment above the body vof the patient; and means supported on the side operative‘ to, drop its ?uid spray into the conduit wall of the cover to heat and saturate and circu and to ‘aspirate the air from the main compart 5 late a stream of air through the compartment, ment into and through the conduit, and thence said‘ means comprising a conduit of substantially , back into the main compartment; the conduit ‘ J-shape, both ends communicating with the space having a drain at its lower‘ end for the removal compartment, the lower end of the conduit being of any water from the spray that is not absorbed at a lower level and'the top end of the conduit by the air stream, the spray end of the conduit 10 being at an upper level, the lower end opening being disposed to draw the air from the lower of the conduit being fully open to provide a low levels of the main compartment, and the other ‘ velocity ori?ce for the air stream from the space end of the conduit being disposed to direct the compartment, and the top end of the conduit propelled saturated air to the upper level of the being reduced in diameter to provide a’, high ve main compartment. ‘ ‘ 15 locity ori?ce for the air stream to be supplied to 2'. Apparatus for applying moist heat to a lo the compartment; and a water spray head dis calized area of a human body,’ comprising a rub posed at the lower end opening of the conduit to ber base or mattress to receive and support the' drop its spray vertically into the conduit to heat, portion of the body to be treated; a cover of moisten, and circulate the air stream through the inverted U-shape to ?t over that portion of the 20‘ conduit and through the space compartment. body and to removably seat itself on the rubber FERRY C. HOUGHTEN. base with a free space‘ compartment above the MURRAY B. FERDERBER.