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AN EARLY ETHER VAPORIZER DESIGNED by JOHN SNOW a Treasure of the Wood Library-Museum of Anesthesiology

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AN EARLY ETHER VAPORIZER DESIGNED by JOHN SNOW a Treasure of the Wood Library-Museum of Anesthesiology AN EARLY ETHER VAPORIZER DESIGNED BY JOHN SNOW A Treasure of the Wood Library-Museum of Anesthesiology ROD K. CALVERLEY University of Califarnia, San Diego, California, USA he achievements offohn Snow (1813- offer no impediment to the most rapid inspira- 1858) are respected by anesthesiologists tion; and to meet this requirement it must be of all countries. His publications, panicularly wider than the trachea. ."r Although recent the 88-page monograph "On the Inhalation of teconstnrctions of this device are on display in the Vapour of Ether in Surgical Operations," British museums, originals are not. A fortuitous first published in September 1847, are regularly discovery was recently made in the United reprinted and are now more widely read than are States at the American Society of Anesthesiolo' the works of any other l9th-century pioneer of gists' Wood Library-Museum (WLM), Park anesthcsiology. Scholars are deeply impressed Ridge, Illinois. A previously unappreciated by the broad scope and rapid development of his instrument has been identified as an authentic scientific observations. Clinicians admire inhaler of lohn Snow's design. It now ranks Snow's ability to relate his research to clinical among the most prized objecs of the WLM practice. Distinguished investigators believe that collection. John Snow's underslanding of the scientific Visitors to the WLM marvel that a proto- foundations of anesthesia were unequaled for type of Snow's inhaler could have been de- almost a century. signed, introduced in the medical literature and An example of Snow's skill in intermin- marketed commercially within a month of gling practical concern and scientific observa- Snow's first having witnessed ether anesthesia- tion is his ether inhaler, shown on page 17 of his From the moment when the inhaler was identi- 1847 monograph (Figure l). As the accompany- fied, I have been curious to leam the history of ing text reveals, he selected its components its development. How could Snow have carefully. For example, he chose a breathing prepared it so quickly? Did he create an original tube which ". ought to be so capacious as to design or did he re-assemble components 9l Fig" 1. t*hrr S**r'i* Fisral ${*difrr:*tis* *f hi$ fith€r lnhalcr" devined fbr*ther appllei*tions? If xco vrhat was re*r:*tty pr*h*s*d f*r th* library"As he their original puryase?These qnesNicns reflerted surveyetl the shelves. he saw ths bsx aild my ignorance of l9th-century technologr, a e*sually pl**erl it en *tabte wirh the comrneilr defieieffiycwFqunde.d by alack*f nrcs*s tF that it was bcliEved m be an early nitrous oxide .loumatrs of thst period. Recent $pportunitiss tCI inhaler. correspond with British schr:lim and ta visit While the group moved $n t$ in$pect slher historicd libraries ia Britain, have given me a objects, I opened thc box. The largest obje*s better {rndsrstending af thc origins of ths within it we{e a csiled tube and a black rncni vap*ril*r'r {sffip*{ts,ftt$. For readers who, tike tin, A cursary exanrination showed that the m*,enjlry r***lving historical pu;*les. I rvculd rimall, circular and ruther shallow tin. about 5 tike lc',***crih* my "p*th of discsvery" *hronc- inshcs in,,*i*r*ct*r aad ?-1n inches deep. could togicdly kom when I frrst saw this intriguing not hsve been constructed tB contain a ga*; it devieq. h*d t*r hav* bseftd&signed t* r*qe-iv* x:li,#lid, whiqh from thevelumee$nt*inod w*nlik*ly to trdentificction of tfu Anesthcsia Inhnler be ethcr. Although slightly rust€d, the metal tin In l9?9 the Trustess of the WLM pur- *herrsd $$ rnarks uf usa Wittr * rdini*i*n's shaxnd aH.*A*acst*esis lfihsler"- frsm $ims* curi**ily, I ass*mhled the components; a rourrd Kay, s Lcrd*,n ffr*iqs€ d**I*r fsrf,54$, lt* metfll vaporizing chamber, s hras$ quadrant provelrance was, gnd still rcmains, unknown. vslve which *ould bd turn*d to allow the For nn*ny years thereafter it rested undisturbed in*pire.d vspor to be dilutcd with room air, a ?8- in its fincly er*fted wqd{:*n bsx oc}a *helf in the inch-long floxibls rube with En inwmal diameter 'IYLM mrc book rcom.It cnn:e t**llsntion sf $/8 af tn inoh, a wsodcn T-pierx connector again when Dr. f,rsrth &u*[pg sfuolltcd the WLht and a glass rnoutlrpiec*. Wirhout deliberate Trust*es somc valuable books that h*d bfen thought, I reflexively te*t*d rny ncwly as- *? - Txx Tkrno trxrEnr*nos,u" Sy?i$r}*i!*r tr${ ?*rs **txxt *r Axerrxffita sembled circuit by placing the mouthpiece Faulconer and Keys expressed the opinion that against my lips and inhaling. To my chagrin, I Wood's complete apparatus was manufactured immediately drew the dust of decades deep into by Ferguson.3 The WLM inhaler was produced my lungs provoking a violent cough. As the by a leading British manufacturer of the period, exhaled dust flew from the distal arm of the T- but the identity of its designer remained a piece, I heard the lick of a valve closing, a mystery. sound which excited greater curiosity. I disas- This problem resolved unexpectedly when sembled the T-piece and found that it contained Dr. Samuel Tirer sent me a manuscript to two wooden spheres of 5/8-inch in diameter review along with photocopies of pages from positioned as caged inspiratory and expiratory the Lancet of 1847. Fortuitously, even though it valves. Until that moment I had not appneciated was not the topic of his research, my friend that valves very similar in concept to the non- included an illustration which riveted my rebreathing valves of mid-2OOth-century attention because it depicted an inhaler almost construction had been used many decades identical to that in the WLM collection. The earlier. accompanying text reported the January 23, As I continued my examination, I was 1847, meeting of the Westminster Medical caught up in admiration for the utility of the Society. The first sentence began, "Dr. Snow vaporizer's design and searched for any placed on the table an apparatus for the inhaling information that would identify its gifted of the vapour of ether.a The WLM Trustees designer. The wooden box was unlabeled, but a were soon delighted to leam that the vaporizer, small brass plate on the vaporizer read: which had rested in obscurity in our museum, "Ferguson was a product of John Snow's genius! 221, Giltspur Street" Tlte Inncet diagram included details of The WLM librarian, Patrick Sim, and I the vaporizer's construction. Although the were unable to find a reference to Ferguson in device Snow demonstrated in January 1847 K. Bryn Thomas' "The Development of lacked the quadrant valve to permit the mixing Anaesthetic Apparatus" or other British and of ether with room air, it was otherwise very American historical texts. We did, however, similar to the WLM vaporizer. The article find Ferguson of Giltspur Street, London, included a schematic internal view which among the manufacturers listed in a copy of revealed a spiral plate within the vaporizing Elisabeth Bennion' s catalog, "Antique Medical chamber similar to that shown in Snow's Instruments," but did not find a vaporizer monograph. The accompanying description among her illustrations of Ferguson's equip- revealed Snow's awareness of the advantages ment. From Bennion's history of the Ferguson provided by the water bath. He stated: company, we were able to derive the period of When used, the inhaler was to be put its manufacture as follows: Ferguson had in a hand-basin of water, mixed to a relocated to Giltspur Street in 1828; the firm's particulu temperature, conesponding to the propofiion of vapour name changed to Ferguson & Son in 1851; that the operator might desire to give; and the caps being therefore, our vaporizer must have been removed, and the mouth-tube attached, manufactured before l85l and after December when the patient began to inhale, the air 1846 when the news of ether anesthesia crossed would gain the desired temperature in the Atlantic to Britain. passing though the metal pipe; it would Some time later I unexpectedly found an then come upon the surface of the ether, appreciation of Ferguson's work when re.ading where it would have to wind round three or the papers of Dr. Alexander Wood, the four times before entering the tube going to Edinburgh pioneer of subcutaneous injection. the mouth-piece, thus ensuring its full Wood incorporated into his ingenious develop- saturation, and preserving it at the desired ment of the syringe and hollow needle.2 In 1965 temperature. There was no valve, or any 93 -Roo K. CelvmI"ev other obstruction to the air, till it reached vaporizer was the second prototype of the well- the mouth-piece, which was of the kind known Snow ether vaporizer which we find used in other inhalers, and contained the illustrated within its rectangular metal water prevent valves necessary to ttre return of the bath.I could now follow the evolution of his expired air into the apparatus.r vaporizer from is original version as illustrated A rcview of theLondonMedical Gazette of in January, 1847 inlancet through the interme- 1847 revealed an article of March 19, 1847 in diary modification in the WLM collection and which Snow described a vaporizer which then to its final form in the Snow September featured a quadrant valve that had been de- lM7 monograph.
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