The development of inhalation anaesthesia : with special reference to the years 1846-1900... / [Barbara M. Duncum].

Duncum, Barbara M.

Date:: 1947

Credit: The development of inhalation anaesthesia : with special reference to the years 1846-1900... / [Barbara M. Duncum]. Source: Wellcome Collection.

621/664 page 601

$country a detailed eye-witness account of Trendelenburg's tampon-cannula in use. He stated in 1872 that the apparatus could be obtained from Krohne and Sesemann, the London firm of surgical instrument makers. In place of the funnel and tubing, Junker said, Esmarch's or Skinner's masks (see Figs. 56, 58-9), moistened with chloroform, could be held against the external aperture of the cannula, or the afferent tube of his own chloroform inhaler (see Fig. 63) could be inserted and a chloroform-air mixture pumped in. In England the use of Trendelenburg's tampon-cannula and method of anaesthesia was never more than occasional, but as late as 1900 D. W. Buxton mentioned its use ' in extensive removals of growths about the jaws ',* adding that * it is quite possible to obtain a most satisfactory anaesthesia with ether.' 2 A year later, in 1901, Hewitt also described the method in con- nection with excision of the larynx and of laryngeal growths (see pp. 608-9). In 1878 William MacEwen, surgeon and lecturer at the Glasgow Royal Infirmary, decided to try the ' introduction of tracheal tubes by the mouth instead of performing tracheotomy or laryngotomy '. He intended the procedure to be used as a means of relieving such conditions as acute oedema of the glottis and also to allow the packing off of the throat and the adminis- tration of chloroform in operations where blood and operative debris were liable to be aspirated into the air-passages. ' Post-mortem experience showed', wrote MacEwen, * that instruments of the tube kind could, after a little practice, be passed with facility through the mouth into the trachea. This was accomplished by introducing the finger into the mouth, depressing the epiglottis on the tongue, and so guiding the tube over the back of the finger into the larynx. In experimenting with various instruments, it was found more easy to introduce those of a large calibre [3], such as Nos. 18 to 20, than instruments 1 Buxton himself had developed a method of rectal etherization for use in such cases. (Buxton, D. W. 1900. Anaesthetics: their uses and administration. London. 136-9.) 2 Buxton, D. W. 1900. Anaesthetics: their uses and administration. London. 40. 3 In a letter addressed to the Nuffield Department of Anaesthetics, dated 28/3/40, Dr. W. B. Primrose, of Glasgow, stated that he had discussed this method of endo- tracheal intubation with Sir William MacEwen's son, who has in his possession two of the original tubes. ' One is a piece of flexible brass about 9 inches long and about I inches diameter ending in a bevelled tip. The other is a wire coil about 4 inches long ending in a pointed nozzle with 4 lateral apertures : this looked like \ in. or TV in. diameter and presumably required some kind of introducer.' Dr. Primrose added that ' this seemed an extraordinarily large instrument to pass through the glottis '.$