US 1799692 A
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April 7, 1931. c. KNQTT OPERATING STAND a m mz Filed Aug. 1925 2 Shegt$ -$h 1 April 7, 1931. g; KNQTT 1,799,692
/ OPERATING STAND Filed Aug. 8, 1925 2 Sheets-Sheet 2 Patented Apr. 7, 1931 UNITED STATES PATENTOFFICE CHARLES KNOTT, OF NEW BIADRID, MISSOURI; ST. LOUIS UNION TRUST COMPANY, IN CORPORAIEID, EXECUTOR OF SAID CHARLES KNOTT, DECEASED OPERATING STAND Application filed August 8, 1925. Serial No. 48,993.
This invention relates to improvements in the art of performing operations,and to ap paratus applicable for that purpose.
Many types of tables and stands have heretoforebeen suggested and builtfor the assistance'of surgeons in performing operations. Most of these tables were without capability of adjustment of the position of the patient during the course of the opera- 0 tion, and in particular were designed for the performance of theoperation from above, in which position the collection of blood from severed arteries and veins obscured the proper situs of operation and required the attendants to keep this situs clear. Further,
in general, the position for the operations, in
the cases of anesthetized patients was with the patient resting upon the stomach or back.
After the operation was over, it was necessary to immediately move the patient from the operating stand or table onto a portable stretcher or stretcher truck, and possibly later to remove the patient from this stretcher to a ward cot.
It is the purpose of the present invention to present a method of performing operations in which the situs of the operation is not obscured by blood, and in which the patient is presented to the surgeon, instead of the surgeon having largely to adjust his position to correspond with the position of the patient. This is accomplished by the provision of an improved operating stand, in which the patient may be fastened against movement during the manipulation of the stand, and which may be rotated into any desired position; and which is provided with a bottom or supportin surface which may be arranged in various ways to disclose the situs of operation to the surgeon, and yet supports the patient at all other points. In particular, this bottom is composed of interchangeable sections fitted to a frame, so that any desired and necessary part of the patients body may be exposed through the same; so that the surgeon may operate substantially from the bottom, thus permitting free drainage from the incision. This frame is supported in the stand to permit free access by the'surgeon and his assistants; and the stand may carry upon itself the necessary accessories for the operation. In this way, the floor incumbranceis diminished, and the work of sterilizing the room is facilitated. A further feature of the particular stand, is that these frames are removable and constructed as stretcher frames, and may serve for bringing the patient to and from the stand, and if deemed necessary by the surgeon, the patient may be left upon the removed frame for as long as necessary following the operation, and thus the danger of breaking sutures by moving is eliminated. In the preferred form of assembly, the various'component members may be separated for sterilization or shipment without total dismounting of all the elements.
'IVith these and other objects in view, as will appear in the course of the following specification and claims, I have shown upon the accompanying drawings one form of execution of my apparatus by which the new method may be practiced, with, several modilications of details; and in them:
Fig. 1 is an end elevation of such a structure.
Fig. 2 is a side elevation, representing a patient in one position thereon.
Fig. 3 is a section on line 33 of Fig. 2.
Fig. f is a plan of a stretcher with two bottom boards in place thereon. f
Fi 5 is a side elevation of the assembly of Fig. 4.
' Fig. 6 is .a section through a stretcher,
showing'a method of securing a patient therethe following parts: a stand supported upon the floor of the operating room, and having means thereon to raise and lower and rotate a pair of coaxial spindles, and furthermore having accessory parts for the support of surgical appliances; (2) holders carried by these spindles which permit the easy insertion and securing of a stretcher frame priorto the operation, and its easy and gentle withdrawal thereafter; (3) a stretcher frame which is adapted to be received and held in said holders, and be raised and lowered and rotated in said stand to a position most convenient for the surgeon; (4) interchangeable bottom boards for the stretcher frame, which may be assembled upon the frame and some of which are adapted to fit a patient and retain his body against movement, while others expose desired portions of the body, including the situs of the operation through the bottom boards; means for securing a patient to said stretcher frame.
The stand has the floor supports 10, and the pair of posts 11, 12 arranged at each end and constituting standards. These posts are joined at the top by the cross-pieces 13 held in brackets 14 at the four corners, while the posts are braced lengthwise by the poles 15 and 16 at top and bottom. Preferably only one pole 16 is employed at the bottom, so that the space immediately below the stretcher is free for the surgeons work. At each end of the stand is a carriage 17, which. slides freely up and down on the poles 15, 16. Mounted in a bearing in a bracket 18 at the top of the stand at each end thereof, is a shaft 19 which for the lower portion of its length is squared, and is received in a squared hole in a worm 20. This worm is carried in a support 21 on the carriage, so that during its rotation it remains in an invariable position with regard to the carriage. 'At the upper end, the squared shaft 19 carries a bevel gear 22, which meshes with a similar gear 23 on a shaf 24 which extends the length of the machine. In this way, the
squared shafts 19 are connected so that they turn in unison, and carry the worms 20 with them in their movement. On the other hand, the squared shafts slide freely in the worms 20, so that as the carriage is raised and lowered, the transmission is maintained. Mounted on the outer side of one of the supports 21 is a bevel gear 25 which meshes with a bevel gear 26 on the squared shaft 19: a crank handle 27 serves to rotate the bevel gear 25, and this in turn to move the bevel gear 26, so that thereby the squared shafts at each end are turned in unison from a single station. I
Likewise journalled in the carriages 17 are the spindles 28 which are provided at the ends outside the carriages with worm wheels 29 meshing with the worms 20 on the squared shafts. As the worms 2O revolve, the spindles 28 are rotated at a lesser speed: and if the worms are held stationary, the spindles 28 are locked against movement. At the inner end of the spindles 28 are the stretcher holders 30 to which reference in detail will be made hereinafter.
In order to be able to easily raise and lower the carriages 17, a threaded spindle 31 is provided at each end of the stand, reeeived in a threaded engagement by the respective carriage 1'7, and journalled at the top of the stand in the bracket 18, and carrying keyed thereto a bevel gear 32. These bevel gears mesh with the bevel gears 38 on the opposite ends of the shaft 34 which extends the length of the stand, so that they may be rotated in unison by the crank handle 35 connected to one of them.
It is apparent that by this means, a single attendant at the left hand end of the machine as shown in Fig. 2 is enabled to adjust the position of the patient in height and angle to suit the requirements of the surgeon.
To facilitate sterilization and shipment, the apparatus may be dismounted in sections. For this purpose, the bar 16 may be provided at its ends with oppositely threaded screws or similar devices so that it may be quickly connected with the floor pieces 10. The poles 11 and 12 are provided with the rabbeted joints at 11 and 12' above the bracket 18, so that the top assembly may be released by the pins 11 and 12 and removed. Each of the standards is then separated. The whole apparatus in this way may be enclosed in a chamber or packing box of length approximating the length of the top section, and of slightly greater cross-section.
Various surgical equipment may be secured to the stand, such as a flushing tank, which may be suspended from an adjustable support 36, carried on the cross-bar 37. This cross bar has a bifurcated end 38 to embrace one of the poles 41, and an offset 39 at the opposite end to form a guide, and outside the frame carried a clamp and setscrew 40 to adjust and hold the support 36 in position.
The stretcher frame employed with this stand has two poles 41 and two end braces 42, all rigidly assembled together, and at each end of the poles a lug 43 which serves to hold the stretcher frame against longitudinal movement in regard to the holders 30. These holders 30, as shown in Figs. 8 and 9, each have a pair of parallel guides 44 with a closed end 45, and outwardly flared opposite ends 46 which serve to guide the stretcher poles into position. Intermediate the ends, so that the stretcher will usually be substantially balanced laterally, is a connecting web 47, which as shown in Fig. 2, is U-shaped and deep enough so that the handles of the poles 41 projecting beyond the end braces 42 may be easily received within the holder. In, order to hold the stretcher frame in position.
even though the same be rotated the full weight comes towardsthe flared ends 46, a bolt 48 may be slipped through asfshown in Fig. 8, or a pivoting clip 49 employed as shown in Fig. 9, in which latter case, the spring 50 may be fastened thereto to'engage in the slot of the pivoting screw 50 to hold the clip in open and closed positions.
This stretcher frame is adapted to have any desired type of bottom board placed thereon: such boards are indicated in Figs. 2, 4, 5, 6, 7, 10 and 11; and it will be understood that in general any desired type of board may be placed upon the frame and that such boards are interchangeable with one another, and maybe assembled in any order and relation as the surgeon may determine tobe most convenient and comfortable to the-patient and himself.
The types shown in Figs. 4 and 5, for ex: ample, are adapted for rectal and similar operations, in which the patient'is disposed with his back against the board 50, andresting at the thighs against the hinged projections 51, to carry the weight. The center of the board is cut away at 52 to expose the situs, and the board is supported on the frame by the straps 53 and 54, which may be adjusted as desired to bring the patient into position, for example by the buckles 55. The projections 51 are supported at any desired angle by the adjusting chains 51 The legs of the patient may be disposed upon the bottom board 56 to be out of the. surgeons way: straps may then be passed through the slots 57 and 58 to hold the legs in position. It is obvious that the boards may be adjusted to patients of differing dimensions. WVith this arrangement, the patient may bemoved to a horizontal, stretched-out position, withoutremoval from the stretcher, and with his legs still fastened to the board 56, by raising the lower end of board 50 and permitting'the projections 51 to be lowered into the plane of the board 50: the situs of the operation may remain under scrutiny during this manoeuvre, and the board 56 is slid along the'poles 41 as required. r i
Another type of bottom board 59 is shown in Fig. 6, in which the curve may be adapted to a desired part of the body of a patient of a particular height and weight: a strap 60 may be passed around the patient, and is held at one end by. being passed through a slot in the bottom board and retained by a pin 61 passed through its looped end. The other end of the strap may be passed downward through a similar slot at the other side of the patient, and then brought back and passed through a buckle 62 carried by a branch strap 63. By this arrangement, the buckle does not come in contact with the patients body.
A further type of bottom board is shown at 64 in Fig. 7, in which the curved bottom change of position relative to the bottom boards.
By the type of bottom board shown in Figs. 10 and 11, and at the stomach section in'Fig. 2, the sides of a patient may be supported, while still disclosing the situs of operation. In this form the end boards 65 pass from one pole 41 to the other, and serve as supports for the ends of the longitudinal slats 66 at each side of the patient. The distance between these slats may be exactlyadjusted and maintained by the turnbuckle screws 67 which engage in eyes 68 on each slat 66; The position of the aperture thus afforded may be brought opposite the desired point of the patients body laterally by sliding the slats 66 with regard to the end boards 65. v This type of board is valuable where only a small portion of the skin may be exposed, and where it is desired to support the tissues immediately adjacent the situs.
Around andabout the chosen situs, in the form shown in Fig. 11, are located the buttons 69, which are used by the surgeon for aiilzaching artery sutures, flesh hooks, and the li e.
Another type of bottom board, which may be employed in anesthetizing patients presented upon the bottom boards prone upon their stomachs, is shown at 70 in Fig. 2,
which has a foreheadband 71 and a chin strap 72 to hold the patients head with the face downward. Anesthesiain this position is advantageous, since thepatients tongue .is held. out by gravity,
- These are illustrations of the shapes of. bottom boards which may be employed. The sizes and curvatures may be designed for patients of dififerent heights and weights, and may be in sections of any length. These boards are preferably secured to the stretcher frames, so that the frame may be turned upside down with the patient thereon, if so desired by the surgeon. i
By use ofthisapparatus, the situs for the operation is presented to the surgeon frombelow the bottom boards, so that he may makehis incisions and do his work from the bottom, so that blood or other liquids may flow readily to the exterior, instead of being received and confined within the body cavities. This feature is of especial value in operations for cancer, appendicitis or blood poisoning, where these liquids are dangerous to the bodily integrity of the patient. The surgeon has the entire space below the stretch-; er free, and available for tools; flushing and serum tanks may be fastened to the stand, and their discharge tubes led downward so as not to interfere with the free observation of the situs by the surgeon.
After the operation is completed, the stretcher frame may be lowered to a proper height, and slid out onto a truck or to the hands of attendants, without disturbance of the patient, who may be left strapped thereto as long as deemed advisable by the surgeon. The individual bottom boards may be replaced by boards of other shapes, by boards having mattress sections, etc., without substantial disturbance of the patients position. Meanwhile, further stretcher frames with bottom boards of the same or another shape may be prepared, and patients operated upon, in the same general manner.
1. In an operating stand, a pair of standards, a vertically movable carriage upon each of said standards, means to raise and lower said carriages upon said standards in unison, spindles carried by said carriages, means to rotate said spindles in unison, stretcher holders carried by said spindles, a stretcher frame having means thereon to permit it to be inserted in said holders, and means to prevent movement of said stretcher frame when in said holders.
2. In an operating stand, a pair of stand ards, a pair of vertically movable carriages, means on the standards to raise and lower said carriages with regard to said standards, a stretcher holder carried by each of said carriages, a stretcher frame having means thereon to permit it to be inserted in said holders, and means on said holders and frame to prevent said frame from movement relatively to said holders, said stretcher frame being rigid and having removable body supporting devices.
3. In an operating stand, a pair of standards, a stretcher holder supported by each of said standards, means on the standards to move said holders relatively to said standards, a stretcher frame having means thereon to permit it to be inserted in said holders, and means on said holders and said frame to prevent said frame from movement relative to said holders, said stretcher frame being rigid and having removable body supporting body devices.
4:. In an operating stand, a pair of standards, means connecting said standards to maintain them in spaced relation, a carriage on each of said standards adapted to move up and down, a spindle carried upon each of said carriages, a worm gear carried by each of said spindles, a shaft supported in each of said standards, a worm keyed to each of said shafts for rotation thereby and meshing with said respective worm gear, a car riage on each of said standards adapted to move up and down, bevel gears on each of said shafts, a connecting shaft, and bevel gears on said connecting shaft and meshing with said first bevel gears for simultaneous rotation of said spindles.
5. In an operating stand, a pair of stand ards held in spaced relation, a stretcher holder carried on each of said standards, means to raise and lower said holders, means to rotate said holders, a removable rigid stretcher frame carried in fixed position by said holders, a bottom in said frame, and means to secure a body to said stretcher frame and bottom during the rotation of said holder.
6. In an operating stand, a removable stretcher frame having rigidly connected side poles and cross-braces, a plurality of interchangeable bottom boards adapted to fit said frame and to be supported by the side poles thereof, a pair of slidable panels supportable at the ends upon said bottom boards, and means to maintain said panels at fixed distance from each other.
7. In an operating stand, a pair of standards, a vertically movable carriage upon each standard, means for raising and lowering the carriages in unison, a rigid stretcher frame, means mounted on the carriages for supporting said rigid stretcher frame, and means for shifting in unison the supporting means for the stretcher frame whereby said stretcher frame may be placed in diiferent set angular planes.
8. In an operating stand, a pair of stand ards, a vertically movable carriage upon each standard, means for raising and lowering the carriages in unison, a rigid stretcher frame, means mounted on the carriages for supporting said rigid stretcher frame, means for shifting in unison the supporting means for the stretcher frame whereby said stretcher frame may be placed in different set angular planes, and removable supporting devices carried by said stretcher frame.
9. In an operating stand, a pair of stand ards, a rigid stretcher frame, devices carried by the standards for supporting said stretcher frame, means for raising and lowering said devices and for holding said devices in set position on said standards, and means operating through said supporting devices for placing said stretcher frame in different set angular planes.
In testimony whereof, I affix my signature.