US 1610947 A
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Description (OCR text may contain errors)
Dec. 14 1926. 1,610,947
E. E. HOSMER BOUGIE Filed March 16, 1921 anvamto'c L. W
' Patented 14, 1926.
UNITED STATES PATENT OFFIGE.
EDWARD EVERETT KOSHER, OF NEW YORK, N. Y.
Application filed larch 18, 1921.
The present invention relates to certain improvements in bougies, or medical Instrumcnts, for insertion into the natural assages of the body, such as the rectal, vaginal and urethral areas, to cause their dilatation,
or in order to apply medicaments therein.
Instruments of this character have lon been known to the medical profession, an their value in the treatment of rectal and urethral disorders particularly has been generally recognized.
As heretofore constructed, the instrument usually is made of a single piece of solid rubber, wood or metal and has an insert portion to cause dilatation. This portion is of rounded configuration and terminates in a blunt point from which the cross sectional area progressively increases to a maximum for an instrument of a given size. In all the various forms of bougies, it has always been the practice to make the surface of the insert port-Ion perfectly smooth. The eflfect produced by the smooth surface insert portion on certam passages of the body, such for example as the anal canal, will be better understood after a consideration of the anatomical structure of these parts, especially the inner walls or linings of such passages.
It is well known that some of the passages of the body, in the treatment of which the bougie is used, have an inner lining or layer of muscular convolutions approximating in form a spiral channel. The inner lining of the small and large intestlnes are illustrations of such a structure. When a boogie of the usual construction is introduced in such passage, as for instance the anal canal, the sphincter muscles are divided and the wall of the canal is subjected, by the insert or distending portion of the in strument, to a pressure depending upon the amount of dilatation. The pressure is applied to the projecting muscular formations and, as well, to the walls pro er, at every point about the circumferentia area of impingement between the smooth surface of the insert port-ion and the inner wall of the canal. Now, since the inner walls constitute the seat of the terminal nerve endings, these nerves are subjected, over the entire area of contact, tothe full distending pressure, with the result that they are to a marked degree paralyzed and rendered incapable of proper functioning. Thus the smooth surface bougie though serving sufliciently to distend the passage, and when suitably pre- Serial No. 468,750.
pressure, only at distributed points, and are free to function.
In obtaining this distribution of pressure, I havegfound it desirable to form the distending or insert portion of the bougie spirally to follow the conformation of the in ner wall structure of the body passage, which not only serves to separate the convoluted projections of the inner wall, but also aids in the introduction of the instrument. Furthermore, as the greatest pressure is distributed along spiral lines, the introduction of the instrument is less disagreeable than is the case with the smooth surface instrument and the depressing effect of the latter on the terminal nerve endings is to a large extent remedied.
The distending or insert portion of the instrument may be provided with spiral ridges, or spiral depressions, or both; or, when the instrument is used without medicaments and for dilatation only, the distending or insert portion may consist of spiral wires alone. When the bougie is used for the application of medicaments, the spiral formamation of the surface acts as a carrier or receptacle therefor, by which the treatment is greatly facilitated, and this is especially so with the spiral depressions Whether or not the surface of the dis-- tending portion of the bougie is of spiral formation, but preferably in combination with such a construction, the invention comprehends as another of its parts a'bougie the-distending portion of which is hollow to receive means whereby the surface of this portion of the instrument may be heated. In the preferred construction, the distending portion is hollow and the instrument has a neck opening leading to the interior of liquid may be introduced therein. A cap is provided for closing the opening, which serves at the. same time as a handle for the instrument. I
In the preferrcdconstruction described hereinafter, the bougie has a rounded insert or distending portion provided with spiral ridges, both the ridges and the insert portion being of progressively increasing cross sectional area from the point of the instrument.
The invention is illustrated in the accompanying drawings in application, as an example, to a rectal bougie having spiral ridges on the insert rtion thereof, in which Fig. 1 is a side vlew of the instrument; Fig. 2 is a section along the line 2-2 Fig. 1, and Fig. 3 is a modification-shown g a ongit-udinal sectional View in which the insert portion is hollow.
The instrument comprises an insert or distending portion 1 of progressively increasing cross sectional area from the point thereof. The surface of this portion is provided with spiral ridges 2, and the instrument has a handle 3. The handle is separated from the insert portion by an annular projection 4 which limits the extent to which the instrument can be introduced in the anal canal. The ridges 2 are of progressively increasing cross sectional area from the point of the instrument, and I have found that the best results are obtained b graduating the ridges from a sixty-fourt of an inch square at the point to three times that size. as to height and twice the size as to breadth at the opposite end of the insert portion. Also, I have found in practice that the number of spirals on a three-quarter inch bougie should be three and the inch and large sizes four to secure the greatest amount of relief to the nerve areas from the distending pressure.
When the instrument is introduced it is given a slight turning movement only inas-. much as the spirals are of relatively high pitch, the spiral ridges engage the spiral for mation ofthe inner walls of the passage, opening them and pressing the walls outwardly along spiral lines. Thus, while the desired amount of dilatation is caused b the outer surfaces of the ridges, the areas fa ling between the ridges are relieved of the direct application of the distending pressure and consequently the nerve endin 1n such areas atre unafiected and retain their normal vital- 1 y.
In Figure 3, the insert portion 1 is hollow, and the instrument has a threaded neck openm 6, communicating with the interior 7 of t e insert portion through which hot llquld may be introduced therein to heat the surface of this portion of the instrument. The handle 3 serves as a cap to close the opening and is made to screw therein,
a washer 8 being provided to secure a watertight joint.
I claim: 1
1. An instrument of the character described having a distending portion of rigid material, and ridges formed on said portion with their-surfaces continuous with the surface of said portion, the ridges com n'ising a plurality of spirals of relatively hig pitch extending in the general longitudinal direction of the instrument and progressively increasing in cross-sectional area as they recede from the point of the instrument.
2. An instrument of the character described having a distending portion of rigid material of bulbous form and terminating in a relatively blunt point, and ridges formed on said portion with their surfaces continuous with the surface of said ortion, the ridges comprising a pluralit o spirals of relatively high pitch exten ing in the general longitudinal direction of the instrument.
3. An instrument of the character described having a'distending portion of rigid material of bulbous form and terminating in a relatively blunt point, and ridges extending from the point throughout said distending portion and formed with their surfaces continuous with the surface of said portion, the ridges comprising a plurality of spirals of relatively high pitch extending in the general longitudinal direction of the instrument and progressively increasing in cross-sectional area as they recede from the point of the instrument.
Intestimony whereof I aflix my signature.
EDWARD EVERETT HOSMER.