Evolution of Boyle's Anaesthesia apparatus

The machine which is used to give general anaesthesia is generally called as Boyle's machine even though there are many other names for that machine.This presentation tries to trace the development of the Boyles machine from 1846.

1. e volution of Boyle’s apparatus It is a misunderstanding that Boyle actually invented the Anaesthetic machine, this is incorrect. On a visit to New York he was persuaded by James. T Gwathmey who was a reservist American Army officer, to try his machine for delivering gases. It did provide an airtight mask with a pressure escape valve. After persuading the board of Governors at St Bart's, he imported two machines. He was to eventually to modify the machine to make it more gas tight. It was given the name  "Boyles Nitrous oxide Ether outfit"   since then the elders of the anaesthetic environment will still refer to this machine as a  "Boyles Machine"  

2. b efore the invention of anaesthesia … s urgery was an agony…a nightmare….

3. Surgery in medieval times.. Often religion based..

4. Entry of nitrous oxide…

5. a dministration of anaesthesia w as not so complicated…..

6. Anaesthetic arnamentorium 1850…

7. Giving anaesthesia became an art r ather than based on any s cientific fact..

8. Inventor and revealer of anaesthetic inhalation by whom , pain in surgery was arrested and annulled… before whom , in all time, surgery was agony…. since whom, science has control of pain October 16,1846 W.T.G.MORTON

9. Cotton ball soaked in sulfuric ether.. a mouth piece and an exhalation port h oused in a glass bottle

10. Codman & Shurtleff Inhaler A mouth piece, shut-off valve, Attachment to bottle with ether/chloroform Air entering port

11. Hager Inhaler -1850 -1860 Used with ether Can force air into the chamber

12. Joseph Clover administering anaesthesia w ith his apparatus See his hands on the patient’s pulse….

13. Clover ether apparatus

14. Mask designed to a dminister ether

15. A well-made antique anesthesia nitrous oxide gas and ether inhaler as introduced, in the early 1900s, by Sir Frederick Hewitt (1857-1916), anesthetist to King Edward VII.  The Hewitt's improved large bore inhaler is a modification of Clover's  portable regulating inhaler.  HEWITT’S APPARATUS

16. WORKING PRINCIPLE OF HEWITT’S APPARATUS

17. JUNKER’S CHLOROFORM BOTTLE

18. ANAESTHESIA APPARATUS –U.K- 1890

19. MAGILL’S ANAESTHESIA APPARATUS

20. MAGILL’S ANAESTHETIC APPARATUS -1920

21. The apparatus includes a "Boyle Bottle" ether vaporizer (right) and a Junker chloroform vaporizer (front). Each is held in a warm water bath, and is connected to a vacuum flask (thermos) that holds hot water. A thermometer registers the temperature inside the flask. A hand pump was used to blow air first through the ether and/or chloroform vaporizers, and then through the vacuum flask on its way to the patient Shipway Apparatus

22. Dr.Elmer.I.Mckesson - invented the McKesson Intermittent Flow Apparatus in 1910. In the same year, he also formed a company to manufacture it. This was the first anesthesia machine to have an automatic cut-off regulated by the patient's breathing. The air stream flowed only while the patient inhaled, and stopped when the patient exhaled, preventing waste. The machine could administer nitrous oxide, oxygen and ether, either singly or in combination. A small rubber rebreathing bag also allowed some of the patient's exhaled carbon dioxide to be reintroduced to the air stream

23. E.M.O VAPORISER

24. E.M.O apparatus with bellows- Ether with a water jacket and a t emperature compensating m echanism.

25. HEIDBRINK MILITARY MODEL

26. Dr. Charles K. Teter (1875-1959) and his brother Dr. William C. Teter (1873-1954) were both dentists who specialized in oral surgery and anesthesia . In 1902, they patented an apparatus to deliver nitrous oxide, oxygen and ether. It may have been the first machine to include all three of these agents. This became the standard combination for all anesthesia machines made over the next two decades. The model shown here is the Teter Regulated Pressure Apparatus, introduced around 1912. TETER APPARATUS

27. The Heidbrink Anesthetizer was among the earliest machines to allow for the administration of controlled concentrations of nitrous oxide and oxygen, and was very popular for dental anesthesia . Heidbrink applied to patent the 'Anesthetizer' in 1912. HEIDBRINK ANESTHETIZER

28. COTTON-BOOTHBY APPARATUS-1911 Dr. Frederic J. Cotton (1869-1938) and Dr. Walter Boothby (1880-1953) were colleagues at the Boston City Hospital when they developed this apparatus for nitrous oxide-oxygen-ether anesthesia .

29. provided an uninterrupted flow of anesthetics and oxygen , a visible indication of the rate of flow for both the nitrous oxide (N2O) and oxygen. means to quickly and easily add ether vapor to the gas mixture. estimating the flow rate: pass each gas separately through water in a glass mixing chamber. The rate of bubbling of the gases through the water was used to estimate the flow and proportion of each gas. The gases directed into the ether chamber could be made to pass over the surface of the ether or bubble through it. The gases could also be directed to fully bypass the ether chamber. The process of estimating the flow rate of gas by bubbling it through a liquid is commonly referred to as the “bubble bottle” or "bubble-through" method. Its influence can be seen in anesthesia devices developed by others, including those developed by Dr. James Gwathmey (1862-1944) of the United States, and Dr. Henry Boyle (1875-1941) of the United Kingdom. Drs. Frederick J. Cotton and Walter Boothby introduced this apparatus in 1911.

30. The Gwathmey -Woolsey Nitrous Oxide-Oxygen Apparatus was developed to administer ether as well as nitrous oxide and oxygen. Introduced in 1912, its design was partially rooted in guidelines for nitrous oxide-oxygen anesthesia recommended by physicians Frederic Cotton (1869-1938) and Walter Boothby (1880-1953), designers of the Cotton-Boothby Apparatus. The most notable similarity between this apparatus and the Cotton-Boothby is the water-sight flowmeter , or ‘bubble bottle,’ which was first developed to estimate the rate of flow for both nitrous oxide and oxygen. GWATHMEY-WOOLSEY APPARATUS

31. CONNELL 1936 MODEL Dr. Karl Connell (1878-1941) introduced a line of closed circuit, multiple-gas anesthesia machines in the 1930s. These were among the first to have a built-in carbon dioxide absorber. This series of machines also had ball-bearing gauges, called flow meters, to accurately display the rate of gases flowing to the patient. Incorporating the suggestions of several leading anesthesiologists of that era, the machine's safety features included glass domes to make the action of the valves controlling the flow of air and gas visible, and conducting wires inside the rubber breathing tubes to reduce the possibility of explosion. These machines also introduced solid stainless steel cabinetry. This model could deliver carbon dioxide, oxygen, ethylene, nitrous oxide and cyclopropane . Ether and helium could also be added. 

32. nitrous oxide (N2O) delivery device that could be carried by midwives into the homes of the women they cared for. Minnitt and King adapted a McKesson device, likely the Nargraf , to create a machine that could be used by the patient to self-administer a mixture of air and N2O. The Minnitt Apparatus was introduced in 1933 and approved by a British oversight authority, the Central Board of Midwives, in 1936 MINNIT APPARATUS- FOR LABOUR ANALGESIA

33. Dr. Henry E. G. Boyle (1875-1941), a leading English anesthetist , invented a nitrous oxide, oxygen and ether anesthesia machine in 1917. It was based on the design of the Gwathmey Apparatus, using a "bubble through" or "sight feed" vaporizer. The gases were routed through two perforated tubes in a glass mixing chamber containing water. The rate of flow could be estimated by observing the force of the resulting bubbles. This became widely known as the Boyle Bottle. The Boyle machine continued in production for over 50 years, while the Boyle Bottle became a standard feature of British anesthesia machines. BOYLE’S APPARATUS

34. FOREGGER -GWATHMEY MACHINE WITH 2 SIGHT FEED TUBES RICHARD VON FOREGGER- ANAESTHESIA EQUIPMENT MAKER 1872-1960

35. A CLOSE UP VIEW OF WATER SIGHT FEED FLOW METER The flow meter system to the left would have had a plain glass jar, filled with water to the level of the bar. Below that bar, each flow meter down-tube is perforated at intervals with holes. In use, increasing gas flow would depress the water in the tube causing gas to escape from increasingly low holes. These levels were calibrated in units of flow which would be read from a card attached to the bottle. The chloroform vaporiser bottle is coloured green while the ether bottle is clear. It is not known why the glass is coloured green,as the recommended colour for bottles for storing chloroform is brown. The chains would have been attached to the filler corks to prevent accidental loss.

36. 1942

37. CONNEL FLOW METER-1936 CO2,OXYGEN AND ETHYLENE

38. CIRCLE ABSORBER-1929

39. WATERS TO & FRO CANISTER

40. COEXTER ANAESTHESIA MACHINE -1940

41. BOYLE’S MACHINE -1940

42. MARRET’S ANAESTHESIA APPARATUS 1942 1950 This machine is the first industrial prototype of Marrett’s portable machine. The vaporiser is an integral metal chamber in a water bath, fed by a dropper from two internal chambers with separate ports on top, with knobs to control flow rate for each agent and cut-off levers. It was used with oxygen, cyclopropane , nitrous oxide, carbon dioxide, ether and trichloroethylene. It was designed for carrying and has a fold-flat handle on top.

43. COPPER KETTLE VAPORISER-1952 Dr. Morris originally designed the vaporizer for the administration of chloroform. Because it worked with any volatile liquid, it was soon used to administer ether, and later halothane. Effective and safe use of the system required thoughtful attention and a strong understanding of the math and science behind the machine .

44. WORKING PRINCIPLE OF COPPER KETTLE

45. The Heidbrink Company introduced the Kinet -O-Meter machine in the mid-1930s. It was influential enough to attract the attention of competitors. Before the end of that decade, the Heidbrink Co. had been acquired by its rival, The Ohio Chemical and Manufacturing Company. For three decades, Ohio kept the well-respected Heidbrink name and continued to make the Kinet -O-Meter, in many configurations and with numerous modifications. Even after Ohio was in its turn acquired by other companies, this widely-used machine continued to be known as "the Heidbrink ". Shown here is the Model 4000, also called the “Compact” Model, introduced around 1963 KINET-O-METER -1963

46. Ohio No8 vaporiser OHIO ANAESTHESIA MACHINE MID 1960s

47. Boyles apparatus -1970 CO 2 flow meter Trilene and Ether bottles

48. BOYLES APPARATUS -1975 Halothane vaporiser Metal soda lime canister Cyclopropane flow meter Attached B.P apparatus

49. ETHER AND TRILENE BOTTLES PLUNGER ‘ U’ TUBE COPPER TUBE IN ETHER CHROME PLATED TUBE IN TRILENE TRILENE LOCK BOYLE’S BOTTLES -1980

50. CYLINDERS -1846 -60

51. This cylinder would have been used for the anaesthetic gas ethyl chloride. It is made of brass and was made in Paris, France. The cooling effect of the volatile liquid was used to produce local anaesthesia. The contents of the cylinder would be sprayed on the site that needing anaesthetising and the area would be cooled by the evaporation of the liquid.

52. The manufacturer of the N2O once held in this gas cylinder (or tank), the S.S. White Dental Manufacturing Company of Philadelphia, was the dominant supplier of dental and medical supplies throughout the 19th century .

53. Pin Index Safety System was introduced in 1952

54. Dr. Jay A. Heidbrink may have first described this valve in a patent that he filed in 1929 for a ventilator. ‘ Heidbrink Valve’ has become a common name for valves of similar design that can be found on many manufacturers’ anesthesia machines.

55. WORKIKING PRINCIPLE OF HEIDBRINK VALVE

56. HEIDBRINK OXYGEN FLOW METER -1912

57. LUCY BALDWIN ANALGESIA APPARATUS -1955 -65 (BOC)

58. Rowbotham’s vaporiser Goldman vaporiser

59. Variable bypass, incomplete vapourisation , flow-over without wicks, low resistance in-circuit, non-agent-specific (but intended for Halothane), no temperature compensation, no interlocks. Glass bowl originally an automotive fuel filter chamber. Economical if taken from place to place (unused agent can be put back in the bottle, no wicks. Used in-circuit. Output decreased due to cooling after induction. Patient hyperventilation if light caused increased output. Mk1 in 1959 with easily bumped 3 position levers, Mk2 in 1962 changed lever to click. GOLDMAN VAPORISER

60. OXFORD MINIATURE VAPORIZER-1960 Variable bypass, flow-over with metal mesh wicks, low resistance, multiple agents, not temperature compensated, light weight. Chamber only contains 50ml of agent. Cooling limits maximum output to 2-4% with halothane.

61. CYPRANE FLUTEC MARK II VAPORIZER

62. WORKING PRINCIPLE OF FLUTEC MkII

63. FLUTEC Mk III

64. SIEMENS SERVO VAPORIZER - 1980

65. Evolution of vaporizers Continue….

66. MAQUET I-FLOW-2010 Where is the flow meter..?

67. WHO IS HE? t ail piece….!

68. What is this?

69. t hank you d r.r.selvakumar p rofessor of anaesthesiology k.a.p.viswanatham govt medical college trichy