Flagg Can

WLMD ID: amxx; anna; annb
Paluel J. Flagg, M.D. (1886-1970) wrote one of the first American anesthesia textbooks, The Art of Anaesthesia; it was published in seven editions from 1916 through 1944. His inventions include the Flagg Can, the Flagg Haemoxometer, artificial airways, endotracheal tubes, laryngoscopes and other apparatus. The first description of what came to be called the Flagg Can appeared in the 1919 edition of his textbook. The original device consisted of a Flagg Airway attached to one end of a length of rubber tubing; the other end of the rubber tube was forced over the open spout of an ether can, and several holes were punched in the top of the can to admit air. Holding the can in one hand warmed the ether and speeded vaporization. Throughout administration, the patient’s nose would be kept closed to prevent dilution of the vapor by additional air. Versions of the Flagg Can appeared in various textbooks from 1916 to 1960.  One of these was recommended for military use in the tropics during WWII, where the climate made it impractical to administer ether by the open-drop method.

Catalog Record: Flagg Can

Three Catalog Records (amxx, anna, annb):

Access Key: amxx
Accession No.: 2016-01-12-2

Title: [Flagg can] / [designed by Paulel J. Flagg].

Publisher: [Place of manufacture not indicated] ; [manufacturer not indicated], [between 1952 and 1998].

Physical Descript: 1 inhaler : metals, rubber, paper ; 5.5 cm in diameter x 19.5 cm.

Subject: Anesthesia, Inhalation – instrumentation.
Subject: Ether, Ethyl.
Subject: Inhalers, Anesthesia.

Note Type: General
Notes: The label on the can states “Division of Olin Mathieson Chemical Corporation”
The first year in the date range is based on the year that Olin Mathieson
acquired E. R. Squibb and Sons. The Squibb division was spun off in 1968,
which gives a latest possible date for the manufacture of the can alone. The
second year in the date range is based on the fact that the inhlaer is known
to have been in the the collection of the Wood Library-Museum by January 1,
1999. The evident age of the rubber tube suggests that the inhaler was made
some decades earlier than that date.

Note Type: Citation
Notes: Buchanan TD. A method of anesthesia for operations on the head and neck. Am J
Surg. April, 1925;39(4)(anesthesia supp):50-51.

Note Type: Citation
Notes: Flagg PJ. The Art of Anaesthesia. Philadelphia: J. B. Lippincott,
1916:123-125.

Note Type: Citation
Notes: Flagg PJ. The Art of Anaesthesia. 2nd ed. Philadelphia: J. B. Lippincott,
1919:147-148.

Note Type: Citation
Notes: Flagg PJ. The Art of Anaesthesia. 7th ed. Philadelphia: J. B. Lippincott,
1944:147-148, 230-231.

Note Type: Citation
Notes: Harvard Business School website, Baker Library, Historical Collections,
Lehman Brothers Collection Finding Aid:. https://www.library.hbs.
edu/hc/lehman/company.html?company=olin_mathieson_chemical_corporation.
Accessed March 4, 2016.

Note Type: Citation
Notes: Kaye G, Orton RH, Renton DG. Anaesthetic Methods. Melbourne: Ramsay,
1946:229-231, 267.

Note Type: Citation
Notes: Klein SL. A Glossary of Anesthesia and Related Terminology. 2nd ed. New
York: Springer-Verlag, 1992:271.

Note Type: Citation
Notes: Leigh DM, Belton MK. Pediatric Anesthesiology. 2nd ed. New York: Macmillan
1960:224.

Note Type: Citation
Notes: Maltby JR. Notable Names in Anaesthesia. London: Royal Society of Medicine
Press, 2002.

Note Type: Citation
Notes: Shields HJ, Gordon RA. Liquid anesthetics. In: Hale, DE, ed. Anesthesiology
by Forty American Authors. Philadelphia: F. A. Davis Company, 1954:256.

Note Type: Citation
Notes: Storni MPC, Lundy JS. Effective administration of ether in the tropics.
Anesthesiology. July, 1944;5(4):380-382.

Note Type: Citation
Notes: Thomas KB. The Development of Anaesthetic Apparatus. Oxford: Blackwell
Scientific Publications,1975:49-51.

Note Type: Physical Description
Notes: One inhaler; Hand-made modification of a Squibb ether can; The front panel of
the label on the can reads: “Flammable [new line] List 4082 [new line] 1/4
lb. Net [new line] Poison [new line] Ether Squibb [new line] FOR ANESTHESIA
[new line] Ether, U. S. P. produced exclusively for anesthetic use. [new
line] Of superior quality and entirely stable while kept in the original
unopened can under normal storage conditions. [new line] Squibb manufactures
anesthetic ether of only one quality, sold only in internally copper coated
cans, thus preserving contents against deterioration which normally occurs in
ether on aging in other types of containers. [new line] ANTIDOTES: —
Artificial respiration; respiratory stimulants; oxygen; fresh air. [new line]
Caution: Federal law prohibits dispensing without prescription. [new line] E.
R. SQUIBB & SONS, NEW YORK [new line] Division of Olin Mathieson Chemical
Corporation”; In the center of this panel, superimposed over the text, are
the words “Copper Protected”; The back panel of the label begins: “Flammable
[new line] Poison [new line] Squibb Ether” and ends “U. S. Patent 2,202,021
[new line] Made in U. S. A.”; There are several wrinkles and small tears in
the label; The top of the can has been pierced by four regularly spaced round
holes, two on either side of the spout; A black rubber hose (17.5 cm long, 1.
5 cm in diameter) has been attached to the can by forcing one end over the
spout; The tube is stiff with age, and numerous small cracks show that it is
becoming brittle.

Note Type: Reproduction
Notes: Photographed by Mr. Steve Donisch, January 12, 2016.

Note Type: Historical
Notes: Pauel J. Flagg, M.D. wrote the second American anesthesia textbook, The Art
of Anaesthesia, published in seven editions from 1916 through 1944. He also
wrote The Art of Resuscitation, and founded the Society for the Prevention of
Asphyxial Death. His inventions include the Flagg Can, artificial airways,
endotracheal tubes, laryngoscopes and other apparatus.

The first description of what came to be called the Flagg Can appeared in the
second edition of his textbook (1919), and was repeated in each subsequent
edition. He did not explain the circumstances of its invention or his first
use of it. The original device consisted of a Flagg Airway attached to one
end of a length of rubber tubing; the other end of the rubber tube was forced
over the open spout of an ether can, and several holes were punched in the
top of the can to admit air. Holding the can in one hand warmed the ether
and speeded vaporization. Throughout administration, the patient’s nose would
be kept closed to prevent dilution of the inhaled vapor by additional air.

In 1925, Buchanan stated that Flagg’s first mention of his “tin can method”
appeared in 1916. However, while it is similar in some respects, the
equipment Flagg describes in the first edition of his textbook is a dropper
bottle and not an inhaler. In 1916, he described making only one pinhole in
the top of the can, and inserting a wick through the spout to act as a
dropper of liquid ether.

In the 4th through 7th editions of this textbook, Flagg suggested a
modification of the device, for administering endotracheal anesthesia; this
replaced the airway with an endotracheal tube. Others further modified the
device by adding a breathing valve. In 1944 Storni and Lundy described a very
similar, improvised technique for use in the tropics; in their method, the
open end of the rubber tube was inserted under the patient’s mask. Versions
of the Flagg Can appeared in various textbooks through 1960, and the device
has a brief entry in Klein’s 1992 Glossary.

Note Type: Exhibition
Notes: Selected for the WLM website (noted January 4, 2016).

Access Key: anna
Accession No.: 2016-01-12-1

Title: [Flagg can] / [designed by Paulel J. Flagg].

Author: Flagg, Paluel J. (Paluel Joseph), 1886-1970.

Publisher: [Place of manufacture not indicated] ; [name of manufacturer not indicated], [between 1919 and 1998].

Physical Descript: 1 inhaler : metals ; 7.5 cm in diameter x 10.5 cm.

Subject: Anesthesia, Inhalation – instrumentation.
Subject: Ether, Ethyl.
Subject: Inhalers, Anesthesia.

Note Type: General
Notes: The first date in the date range is the date of the earliest description by
Dr. Flagg. The second year in the date range is based on the fact that the
inhlaer is known to have been in the the collection of the Wood
Library-Museum by January 1, 1999. Extensive oxidatioin suggersts that it
was modified some decades earlier than that date.

Note Type: Citation
Notes: Buchanan TD. A method of anesthesia for operations on the head and neck. Am J
Surg. April, 1925;39(4)(anesthesia supp):50-51.

Note Type: Citation
Notes: Flagg PJ. The Art of Anaesthesia. Philadelphia: J. B. Lippincott,
1916:123-125.

Note Type: Citation
Notes: Flagg PJ. The Art of Anaesthesia. 2nd ed. Philadelphia: J. B. Lippincott,
1919:147-148.

Note Type: Citation
Notes: Flagg PJ. The Art of Anaesthesia. 7th ed. Philadelphia: J. B. Lippincott,
1944:147-148, 230-231.

Note Type: Citation
Notes: Harvard Business School website, Baker Library, Historical Collections,
Lehman Brothers Collection Finding Aid:. https://www.library.hbs.
edu/hc/lehman/company.html?company=olin_mathieson_chemical_corporation.
Accessed March 4, 2016.

Note Type: Citation
Notes: Kaye G, Orton RH, Renton DG. Anaesthetic Methods. Melbourne: Ramsay,
1946:229-231, 267.

Note Type: Citation
Notes: Klein SL. A Glossary of Anesthesia and Related Terminology. 2nd ed. New
York: Springer-Verlag, 1992:271.

Note Type: Citation
Notes: Leigh DM, Belton MK. Pediatric Anesthesiology, 2nd ed. New York: Macmillan
1960:224.

Note Type: Citation
Notes: Maltby JR. Notable Names in Anaesthesia. London: Royal Society of Medicine
Press, 2002.

Note Type: Citation
Notes: Shields HJ, Gordon RA. Liquid anesthetics. In: Hale, DE, ed. Anesthesiology
by Forty American Authors. Philadelphia: F. A. Davis Company, 1954:256.

Note Type: Citation
Notes: Storni MPC, Lundy JS. Effective administration of ether in the tropics.
Anesthesiology. July, 1944;5(4):380-382.

Note Type: Citation
Notes: Thomas KB. The Development of Anaesthetic Apparatus. Oxford: Blackwell
Scientific Publications,1975:49-51.

Note Type: Physical Description
Notes: One inhaler; Modification of a commerical ether tin; The top of the can has
been pierced by three regularly spaced holes; Spout stands 1.5 centimeters
taller than the top of the can; Extensive rust on the body of the can but not
on the spout.

Note Type: Reproduction
Notes: Photographed by Mr. Steve Donisch, January 12, 2016.

Note Type: Historical
Notes: Pauel J. Flagg, M.D. wrote the second American anesthesia textbook, The Art
of Anaesthesia, published in seven editions from 1916 through 1944. He also
wrote The Art of Resuscitation, and founded the Society for the Prevention of
Asphyxial Death. His inventions include the Flagg Can, artificial airways,
endotracheal tubes, laryngoscopes and other apparatus.

The first description of what came to be called the Flagg Can appeared in the
second edition of his textbook (1919), and was repeated in each subsequent
edition. He did not explain the circumstances of its invention or his first
use of it. The original device consisted of a Flagg Airway attached to one
end of a length of rubber tubing; the other end of the rubber tube was forced
over the open spout of an ether can, and several holes were punched in the
top of the can to admit air. Holding the can in one hand warmed the ether
and speeded vaporization. Throughout administration, the patient’s nose would
be kept closed to prevent dilution of the inhaled vapor by additional air.

IN 1925, Buchanan stated that Flagg’s first mention of his “tin can method”
appeared in 1916. However, while it is similar in some respects, the
equipment Flagg describes in the first edition of his textbook is a dropper
bottle and not an inhaler. In 1916, he described making only one pinhole in
the top of the can, and inserting a wick through the spout to act as a
dropper of liquid ether.

In the 4th through 7th editions of this textbook, Flagg suggested a
modification of the device, for administering endotracheal anesthesia; this
replaced the airway with an endotracheal tube. Others further modified the
device by adding a breathing valve. In 1944 Storni and Lundy described a very
similar, improvised technique for use in the tropics; in their method, the
open end of the rubber tube was inserted under the patient’s mask. Versions
of the Flagg Can appeared in various textbooks through 1960, and the device
has a brief entry in Klein’s 1992 Glossary.

Note Type: Exhibition
Notes: Selected for the WLM website (noted January 4, 2016).

Access Key: annb
Accession No.: 1996-02-23-1 GG

Title: [Flagg can] / [designed by Paulel J. Flagg].

Author: Flagg, Paluel J. (Paluel Joseph), 1886-1970.

Publisher: [Place of manufacture not indicated] ; [name of manufacturer not indicated], [between 1919 and 1996].

Physical Descript: 1 inhaler : metals ; 7.5 cm in diameter x 10 cm.

Subject: Anesthesia, Inhalation – instrumentation.
Subject: Ether, Ethyl.
Subject: Inhalers, Anesthesia.

Note Type: General
Notes: The first date in the date range is the date of the earliest description by
Dr. Flagg. The second year in the date range is based on the date that it
was acquired by the Wood Library-Museum by January 1, 1999. Oxidatioin
suggersts that it was modified some time before that date.

Note Type: Citation
Notes: Buchanan TD. A method of anesthesia for operations on the head and neck. Am J
Surg. April, 1925;39(4)(anesthesia supp):50-51.

Note Type: Citation
Notes: Flagg PJ. The Art of Anaesthesia. Philadelphia: J. B. Lippincott,
1916:123-125.

Note Type: Citation
Notes: Flagg PJ. The Art of Anaesthesia. 2nd ed. Philadelphia: J. B. Lippincott,
1919:147-148.

Note Type: Citation
Notes: Flagg PJ. The Art of Anaesthesia. 7th ed. Philadelphia: J. B. Lippincott,
1944:147-148, 230-231.

Note Type: Citation
Notes: Harvard Business School website, Baker Library, Historical Collections,
Lehman Brothers Collection Finding Aid:. https://www.library.hbs.
edu/hc/lehman/company.html?company=olin_mathieson_chemical_corporation.
Accessed March 4, 2016.

Note Type: Citation
Notes: Kaye G, Orton RH, Renton DG. Anaesthetic Methods. Melbourne: Ramsay,
1946:229-231, 267.

Note Type: Citation
Notes: Klein SL. A Glossary of Anesthesia and Related Terminology. 2nd ed. New
York: Springer-Verlag, 1992:271.

Note Type: Citation
Notes: Leigh DM, Belton MK. Pediatric Anesthesiology. 2nd ed. New York: Macmillan,
1960:224.

Note Type: Citation
Notes: Maltby JR. Notable Names in Anaesthesia. London: Royal Society of Medicine
Press, 2002.

Note Type: Citation
Notes: Shields HJ, Gordon RA. Liquid anesthetics. In: Hale, DE, ed. Anesthesiology
by Forty American Authors. Philadelphia: F. A. Davis Company, 1954:256.

Note Type: Citation
Notes: Storni MPC, Lundy JS. Effective administration of ether in the tropics.
Anesthesiology. July, 1944;5(4):380-382.

Note Type: Citation
Notes: Thomas KB. The Development of Anaesthetic Apparatus. Oxford: Blackwell
Scientific Publications,1975:49-51.

Note Type: Physical Description
Notes: One inhaler; Modification of a commercial ether tin; A ring of ten holes has
been pierced in the top of the can; The spout stands less than 1.5
centimeters taller than the top of the can; Oxidation in various spots.

Note Type: Reproduction
Notes: Photographed by Mr. Steve Donisch, January 12, 2016.

Note Type: Acquisition
Notes: Gift of the University of Vermont, Fletcher Allen Health Care, Inc.

Note Type: Historical
Notes: Pauel J. Flagg, M.D. wrote the second American anesthesia textbook, The Art
of Anaesthesia, published in seven editions from 1916 through 1944. He also
wrote The Art of Resuscitation, and founded the Society for the Prevention of
Asphyxial Death. His inventions include the Flagg Can, artificial airways,
endotracheal tubes, laryngoscopes and other apparatus.

The first description of what came to be called the Flagg Can appeared in the
second edition of his textbook (1919), and was repeated in each subsequent
edition. He did not explain the circumstances of its invention or his first
use of it. The original device consisted of a Flagg Airway attached to one
end of a length of rubber tubing; the other end of the rubber tube was forced
over the open spout of an ether can, and several holes were punched in the
top of the can to admit air. Holding the can in one hand warmed the ether
and speeded vaporization. Throughout administration, the patient’s nose would
be kept closed to prevent dilution of the inhaled vapor by additional air.

In 1925, Buchanan stated that Flagg’s first mention of his “tin can method”
appeared in 1916. However, while it is similar in some respects, the
equipment Flagg describes in the first edition of his textbook is a dropper
bottle and not an inhaler. In 1916, he described making only one pinhole in
the top of the can, and inserting a wick through the spout to act as a
dropper of liquid ether.

In the 4th through 7th editions of this textbook, Flagg suggested a
modification of the device, for administering endotracheal anesthesia; this
replaced the airway with an endotracheal tube. Others further modified the
device by adding a breathing valve. In 1944 Storni and Lundy described a very
similar, improvised technique for use in the tropics; in their method, the
open end of the rubber tube was inserted under the patient’s mask. Versions
of the Flagg Can appeared in various textbooks through 1960, and the device
has a brief entry in Klein’s 1992 Glossary.

Note Type: Exhibition
Notes: Selected for the WLM website (noted January 4, 2016).