Reprinted with permission from Ostomy Canada Magazine, Spring 2006 -Vol. 14, No.1
Use your imagination.
Let’s go back in time to a period about fifty years ago. Imagine a laboratory with a bespectacled scientist wearing a stained lab coat, surrounded by beakers, test tubes and containers percolating with gooey, smelly substances. There’s a distinct sound of something boiling somewhere. He shuffles toward the boiling pot and begins stirring a dark, almost black, concoction with a small metal spatula. His eyes open wide and a broad grin begins to move across his face. At last! He’s found what he’s been looking for. After years of searching, here it is at last. But does he shout “Eureka!”? No. He shouts “Karaya! Karaya,! Karaya!” A new adhesive. Well, so much for this fantasy. But, how Karaya came to be, is immaterial here. This was the special glue that you may remember as your lifesaver.
Karaya was perhaps the first skin-friendly adhesive to be used in ostomy appliances to keep pouches firmly attached to the abdomen. It was the glue that gave us the freedom to wear a pouch without a belt. Sure, the pouches didn’t always behave the way we expected. Sometimes, especially during very hot spells or during strenuous activity, the Karaya seal on the pouch would let go. “Accidents” were to be expected. Those who didn’t like these accidents, always wore a belt!
Today’s modern appliances have excellent adhesives, and only a few of us need a belt for added security. Although pouches with Karaya are still available, there are literally hundreds of high quality appliances made with space-age materials in Canada alone, never mind the rest of the world. These appliances are waterproof, leak-proof, odour-proof and almost fool-proof. And they stick! No belt required. Technology has certainly come a long way!
Let’s go back even further in time – when rubber was still the best material available – a time when plastics like nylon and vinyl were considered ‘new discoveries’ and still in their infancy.
In the archives of the Hamilton & District Ostomy Association, there are a number of examples of ostomy equipment from forty to sixty years ago. They’re new, but very old! Someone, perhaps one of the long departed members, had collected them from far and wide. The items were discovered in boxes in a dusty corner of the chapter’s meeting room. These are treasures, not trash. With the help and friendly advice given by Ostomy Toronto member Dianne Garde, ET, the approximate date, manufacturer and purpose of each appliance was determined. The origin of some are still a mystery.
My wife, Ann, the chapter librarian and archivist, is a lover of anything historical. She has done some research on the items, has labelled each with a yellow tag, and puts these old appliances on display once or twice a year at meetings. They always become items of great interest when displayed at chapter meetings, especially when they are displayed during appliance fairs when the reps of ostomy manufacturers show off their newest appliances. When the reps and visitors see the old appliances, there’s often a look of horror on their faces, especially the younger members. Many remark that they’re fortunate to have had their surgery after ‘modern’ appliances were invented. Then there are some who will mention that they remember a relative that had ‘one of those things’ I recall someone saying, “They look like medieval instruments of torture.”
Back up a bit. The items in the archives were ‘modern’ at one time in history. Now they’re antiques, but a lot of time and money, research and development went into them. They were the best you could get way back then. The first pouch similar to today’s plastic bags only appeared after World War II had ended. And, there was no guarantee that these ‘new’ plastic pouches would be odour-proof anyway, so, because these plastic bags looked so flimsy, it took a while before ostomates considered them as alternatives to rubber pouching systems. Plastic would soon be here to stay and become an absolute necessity for ostomates.
Here are a few of those long-forgotten ostomy appliances. Most of these antiques were very pricey, bulky, heavy and complicated to use. Some were well designed with the ostomate’s well-being in mind. But all the appliances in these photos needed a belt to stay put as Karaya was still in the laboratory!
Let’s start with an inexpensive model.
This artifact is probably one of the more ‘modern’ pouching systems of the time. A colostomy pouch, consisting of four parts – a nylon ‘frame’, a clear plastic bag fastened to the frame by a ‘gum rubber’ ring and a fabric belt that kept the whole thing from falling off the patient’s abdomen- was in use from the 1950s to 1960s. The size of the opening is so huge that my fist fits through it! One can only imagine the itching and burning of the skin around the stoma.
This next device, also from the ’50s and ’60s, is the ‘ABC’ colostomy appliance made by the Canadian company of J.F.Hartz. It was a six piece model! The two photos show the separate pieces. First, there’s of course, the belt and bag. The main piece is a very large and very rigid oval 5 3/4 X 4 1/4 inch nylon flange with a two inch diameter opening in the middle. Then we have a spring wire belt harness twisted to make four loops for attaching a belt. A clear plastic ring with a short spring is used to keep the bag tightly in place (two small screws keep the short spring in place!) Then there’s another smaller clear ring (also held on by two small screws) between the flange and the outer ring. I have no idea why this smaller ring was needed anyway. I think one would have had to be a mechanic to have used this very heavy, bulky and complicated device successfully. As simple as ABC? Not very likely.
This next appliance by United Surgical Company in New York state, available in the ’50s and ’60s, was very thin and light-weight by comparison. This was a four piece model, not counting the two metal belt-fastening teeth. The faceplate was made of hard plastic but the whole thing appears to have been more discreet, a lot less bulky, and would probably have been less expensive.
Now we come to a ‘deluxe’ model – for athletes, I should think. This four piece system was in some ways similar in appearance to modern day appliances with one big difference. It actually had a removable stoma protector (or maybe it had to stay on all the time?) The other striking difference is that the pouch had a small elastic band embedded in the plastic where it attached to the flange. An interesting concept but was the elastic strong enough to withstand the movements of an athlete?
And finally we come to “The Rubber Family”. Some of our members who are, shall we say, long in the tooth, will remember these, I’m sure. These are things nightmares are made of.
We’re going back in time. To the ’30s. Davol was the big name in ostomy appliances, and gum rubber was king.
This first item is a round pouch – how it attached to the flange and what the flange looked like is a mystery. This was made by Davol and was not drainable.
Another Davol product was perhaps the first one-piece drainable pouch that was in common use. Emptying and cleaning the pouch would probably have been a fussy procedure as the flange portion, which was incorporated in the one-piece design, had nooks and crannies that were difficult to clean.
These pouches were intended to be re-usable. No throw-aways. I would imagine that one would need at least two other pouches on stand-by each and every day. How did one close the bottom of the pouch? Guess what? No clip or fastener. You simply had to insert the bottom end of the pouch into two rubber belt loops. I would imagine that leaks were a very common occurrence. And by the way, do you know that rubber absorbs odours? These became very stinky after only a few days wear and had to be washed, soaked, disinfected and deodorized every day. In those days, did anybody even think of allergic reactions to gum rubber? And there weren’t even any ETs to talk to. They hadn’t been invented either!
Now here’s a deluxe colostomy pouch with comfort as its goal. This was a one-piece non-drainable system. A Rolls-Royce if you will, complete with its own spare tire! As you can see from the photo, it has an inflatable ‘doughnut’ that you can adjust to your comfort level. The only snag was, that if the doughnut deflated, you had to find a gas station or bicycle pump to fix the flat! (Maybe it came with its own mini pump!) Believe it or not, this and other Davol appliances were used even into the 1960s.
I know I’ve been poking fun at these old appliances. I surely hope that the inventors won’t read this article, and if they’re still around, that I mean them no harm. It’s not the inventor – it’s the product. Yet, if I had become an ostomate in the 1930s or ’40s, I would probably have been very happy to have a rubber pouch. Fortunately, when I got my ostomy, plastic had already been invented!
And finally, for those readers who are colostomates and irrigate daily, here is a bit of a history lesson for you.
Dr. Bowman, MB, FRCP, was born in Dundas, Ontario, in 1883. He graduated from the University of Toronto in 1906 and for the next two years trained in pathology at John Hopkins Hospital in Baltimore, Maryland. In 1912, He began his medical career at the Hamilton General Hospital, Hamilton, Ontario. In 1919, after serving in the Canadian Army Medical Corps during WW I, he returned to Hamilton where he specialised in proctology, internal medicine and diabetes. Dr. Bowman’s contribution is that he believed in ‘irrigation’ for colostomates and designed and developed his own irrigation system called “The Bowman Improved Colostomy Apparatus.”
The simple concept was: fill the stainless steel jug with warm water and hang the jug two feet above the toilet. After sitting on the toilet, attach the irrigation cup over your stoma using the belt provided (a rubber catheter allowed the water to enter the stoma), and irrigate until you start to feel cramps. Allow the bowel to empty back into the cup and down the toilet by way of a large diameter rubber hose attached below the cup. The patient is warned to repeat the process until the drainage water becomes clear. The instructions on the box cautioned: “A thorough colostomy irrigation can seldom be done in less than forty minutes.”
When the irrigation was complete, an aluminum stoma protector (part of the entire kit but smaller in size than the irrigation cup) was placed over the stoma and held in place using an attached belt. The neat thing is that the belt could be removed from the cup by unsnapping two dome studs. Once unsnapped, the resulting small holes were “for releasing any gas which may accumulate.” The stoma protector was really a colostomy appliance without the pouch. But the cup would certainly have showed beneath clothing.
On a serious note, there’s no doubt that anyone who has experienced wearing these artifacts also experienced a great deal of turmoil in their lives. They became victims twice – once for the disease that resulted in an ostomy – and secondly, society’s lack of understanding and intolerance that caused some ostomates to hide from view and lose self-respect. This to me is the real horror.
Appliance manufacturers have always been at work developing high quality appliances for the sake of ostomates. New research is going on every day for better and safer designs. Although the horrors of the past have not yet completely gone, we now live in a ‘plastic society’ that changes by the second. We also live in an age of Spandex, high fashion and form-fitting clothes and we strive for freedom and good physical health, so ostomy appliances have to be lightweight, discreet, and not one-size-fits-all, unlike those from the past.
I thank my lucky stars that I live in the 21st century!