Intubation

One of the developments that Sir Ivan Magill is best known for is intubation. In 1919, Magill was posted to St Mary’s Hospital in Sidcup, a military hospital that specialised in facial and jaw injuries. Opened in 1917, by 1921 St Mary’s had treated over 5,000 servicemen from Great Britain, Canada, Australia and New Zealand. Because of the nature of these injuries, it was very difficult for the anaesthetists and surgeons to use the traditional anaesthetic face masks, and so Magill and fellow anaesthetist Stanley Rowbotham developed tubing for tracheal intubation. Using this technique, the anaesthetic gases could be delivered directly to the lungs, giving surgeons greater access to the face and jaw, and protecting them from ether exhalations of the patient.

Magill bought the first of the distinctive orange tubes from a football shop on Tottenham Court Road and found that the end of the coil of tubing had the curve needed for intubation. After this shop was destroyed in the Second World War, he worked with Charles King to manufacture the tubes.

Oral and Nasal Endotracheal Tubes, with glass cotainers
Oral and Nasal Endotracheal Tubes c. 1935, with glass containers

 

Though both the nose and mouth could be used for intratracheal intubation, in an article from 1921, Magill notes that ‘the nasal route is even more useful… as it gives the anaesthetist that happy confidence in freedom of airway and the impossibility of blood getting into the trachea’.

To prevent damage to the nasal catheters used for intubation, Magill also developed a pair of forceps in 1920. As well as preventing injury to the tubes, they also allowed the anaesthetist a better view of the larynx. ‘Magill forceps’ are still occasionally used by anaesthetists today, and also by ENT surgeons as the narrow design is useful for removing foreign material from the inside the throat.

A series of Magill forceps, some modified by Magill
A series of Magill forceps, some modified by Magill

 

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