Lumbard & Miller Airways

WLMD ID: akxa, akxb
Anesthesia has many effects on the body, including a reduction in the body's ability to breathe normally. Anesthetics can also relax the tongue enough that it can block the pharynx (the opening at the back of the mouth.) Artificial airways provide a clear passage through which anesthetized patients can breathe. Dr. Joseph Lumbard (1865–1942) specialized in anesthesia at the turn of the 20th Century. He was an early member of the organization that became the American Society of Anesthesiologists. In 1912, he introduced his "tongue controller" airway. This design is open at both ends. The cage construction makes the flexible breathing tube visible while preventing the patient from accidentally biting the tube. In Europe, the Lumbard airway was sometimes incorrectly called "The Mayo Tube". But in fact Dr. Lumbard worked in New York City, and was not affiliated with the Mayo brothers. Dr. Albert H. Miller (1872–1959) was another of the early specialists. He developed groundbreaking techniques, and also led several professional organizations. In 1918-1919, he served as President of the American Association of Anesthetists; this later became the International Anesthesia Research Society. In 1918, he modified the Lumbard airway by wrapping the cage around the distal end. Both Lumbard's original design and Miller's modification of it were popular for over fifty years.

Catalog Record: Lumbard & Miller Airways Lumbard & Miller Airways

Access Key: akxa

Accession No.: 237 A

Title: Lumbard air-way.

Author: Lumbard, Joseph E., 1865-1942.

Corporate Author: Foregger Company.

Title variation: Alt Title
Title: Lumbard oropharyngeal airway.

Title variation: Alt Title
Title: Lumbard’s airway.

Title variation: Alt Title
Title: Lumbard controller of the tongue and palate.

Publisher: [New York] : Foregger, [between 1916 and 1934?].

Physical Description: 1 oropharyngeal airway : metals ; 2.5 x 2 x 11 cm.

Subject: Airway Management – instrumentation.
Subject: Oropharyngeal Airway Devices.

Web Link: http://woodlibrarymuseum.org/museum/item/793/lumbard-&-miller-airways

Note Type: General
Notes: Title taken from markings on the distal end of the airway (based on patient perspective).

Note Type: General
Notes: The early date for the possible year of manufacture is based on the date of the article in which Dr. Lumbard introduced the modified version of his oral airway (1916). The end-year in the date range is an estimate based on information from a 1943 Foregger Company catalog that describes beginning the manufacture of the Miller modification of the Lumbard airway in 1918 and reports that the Miller Modification “substituted the original Lumbard design.” (pg i). Also, The Lumbard airway is in the 1926 Foregger catalog but not in the catalog published in 1935. The date range could change if documentation that indicates the dates should be corrected is discovered.

Note Type: Citation
Notes: Anesthetists meet [medical news]. JAMA. Mary 29, 1920;74(22):1528. https://books.google.com/books?id=TgMcAQAAMAAJ&printsec=frontcover#v=onepage&q&f=false. Accessed February 4, 2014.

Note Type: Citation
Notes: Betcher AM. Historical development of the American Society of Anesthesiologists, Inc. In: Volpitto PP, Vandam LD, eds. The Genesis of Contemporary American Anesthesiology. Springfield, Illinois: Charles C Thomas; 1982:185-121.

Note Type: Citation
Notes: Catalog 1926. New York: The Foregger Company, Inc.; 1926:58.

Note Type: Citation
Notes: Dr. J. E. Jumbard, noted anesthetist. New York Times. October 29, 1942:23.

Note Type: Citation
Notes: Lumbard JE. Anesthesia don’ts [reprint]. [New York?]: [Wood?], 1911. https://archive.org/details/anesthesiadonts00lumb. Accessed February 4, 2015.

Note Type: Citation
Notes: Lumbard JE. A controller of the tongue and palate during general anesthesia. JAMA. May 22, 1915;64(21):1757. https://books.google.com/books?id=yQBBAQAAMAAJ&printsec=frontcover#v=onepage&q&f=false. Accessed February 4, 2015.

Note Type: Citation
Notes: Lumbard JE. Helps in surgical anesthesia. JAMA. November 23, 1912;59(21):1853-1855.

Note Type: Citation
Notes: Lumbard JE. An improved instrument for maintaining an oral air-way, during general anesthesia. Med Rec. November 25, 1916;90(22):941-942. https://archive.org/details/improvedinstrume00lumb. Accessed February 4, 2015.

Note Type: Citation
Notes: Lumbard JE. The present status of anesthesia as a specialty. Am J Surg. April, 1922;36(4)(anesth suppl):34-37. https://books.google.com/books?id=Wj4TAAAAYAAJ&printsec=frontcover#v=onepage&q&f=false. Accessed February 4, 2015.

Note Type: Citation
Notes: On airways: in memory of Dr. Joseph E. Lumbard [Foregger Company advertisement]. Anesthesiology. 1943;4(1):i-ii.

Note Type: Physical Description
Notes: One oropharyngeal airway; Consists of two rows of three parallel curved wires (nickel plated?); The wires are held together by four metal crossbands; The crossbands are located at and near each end; The crossband near the distal end (based on patient’s perspective) is located about 3.5 cm from that end; The crossband near the proximal end is located about 1.3 cm from that end; Both ends are blunt; Manufacturer markings on the distal end include, “LUMBARD” and “AIR_WAY”; Manufacturer markings on the proximal end include, “FOREGGER”.

Note Type: Reproduction
Notes: Photographed by Mr. Steve Donisch, September 18, 2013 with a Miller Modification of the Lumbard Airway (SydneyPlus Key akxb).

Note Type: Historical
Notes: Dr. Joseph Edward Lumbard (1865-1942) designed this oral airway after finding that the solid walled airways, such as the Hewitt or Connell, could become obstructed with mucous. In a 1915 article titled, “A Controller of the Tongue and Palate During General Anesthesia,” Dr. Lumbard introduced the first version of his wire airway. This was followed by a second, “smaller and stronger,” version in 1916. In addition to not being easily clogged with mucous, other advantages Lumbard ascribed to his airway included being easily cleaned and sterilized, and remaining patent (not compressed) if bitten on by the patient.

An oral, also called an oropharyngeal, airway is placed in the mouth so that one end opens just outside of the patient’s lips and the other end opens deep in the throat. It prevents breathing from becoming obstructed when a patient is unconscious during anesthesia.

Dr. Lumbard chose to specialize in anesthesia when it was very unusual for physicians to do so. He practiced at a number of New York hospitals, including the Harlem, Lutheran and Lying-In Hospitals, and taught at University and Bellevue Hospital Medical College. Active in a number of professional organizations, he was a member of the Long Island Society of Anesthetists, which in time became the American Society of Anesthesiologists (ASA). Lumbard was also the 1920-1921 president of the American Association of Anesthetists. This organization was eventually absorbed by the International Anesthesia Research Society (IARS). Lumbard published a number of articles on a variety of topics. A sampling of titles includes, “Anesthesia Don’ts,” “Helps in Surgical Anesthesia,” and “The Present Status of Anesthesia as a Specialty.”

In 1918, according to a 1943 Foregger Company advertisement, Dr. Albert H. Miller (1872-1959) suggested rounding the pharyngeal end of the Lumbard Airway. This proved to be good advice, and it quickly became a very popular option for airway management.

Note Type: Publication
Notes: Lumbard JE. A new, simple, and ready method of dropping ether from the original can. In: Smith AA, Nammack CE, Norrie VH, Coleman W, eds. Medical and Surgical Report of Bellevue and Allied Hospitals in the City of New York. Vol. 3. New York: [Publisher not indicated]; 1907-1908:325-328. https://books.google.com/books?id=ARECAAAAYAAJ&printsec=frontcover#v=onepage&q&f=false. Accessed February 4, 2015.

Note Type: Exhibition
Notes: Selected for the WLM website.

Access Key: akxb

Accession No.: 2013-09-10-1

Title: [ Miller modification of Lumbard airway] / [Miller, Albert.]

Author: Miller, Albert H., 1872-1959.

Author: Lumbard, Joseph E., 1865-1942.

Corporate Author: Foregger Company.

Title variation: Alt Title
Title: Miller airway.

Title variation: Alt Title
Title: Lumbard airway—Miller modification

Title variation: Alt Title
Title: Lombard airway—Miller modification.

Title variation: Alt Title
Title: Lumbard-Miller airway.

Publisher: [New York] : Foregger, [between 1918 and 1962?].

Physical Description: 1 oropharyngeal airway : metals ; 4 x 2 x 10 cm.

Subject: Oropharyngeal Airway Devices.
Subject: Airway Management – instrumentation.

Web Link: http://woodlibrarymuseum.org/museum/item/793/lumbard-&-miller-airways

Note Type: General
Notes: The title is based on the earliest found publication by the manufacturer in which the object is named (1935 Foregger catalog).

Note Type: General
Notes: The early year in the date range that indicates the possible year of manufacture is based on the year that The Foregger Company reports having began the manufacture of the Miller modified Lumbard Airway (in their 1943 catalog). The end-year in the date range is an estimate based on a 1962 Foregger that does not contain the Lumbard-Miller airway.. The Connell, Guedel, Berman, and Waters, and Safar airways are available, but not the Lumbard-Miller. The Lumbard-Miller was available in a 1960 Foregger catalog. The date range could change if documentation that indicates the dates should be corrected is discovered.

Note Type: Citation
Notes: Bastron RD. Albert Heircy Miller: anesthesiology pioneer. ASA Newsl. October, 2005;69(10):16-18. http://www.asahq.org/sitecore/content/ASAHQ/resources/publications/newsletter-articles/2005/october2005. Accessed February 5, 2015.

Note Type: Citation
Notes: Catalog 1926. New York: The Foregger Company, Inc.; 1926:58.

Note Type: Citation
Notes: Catalog 1935. New York: The Foregger Company, Inc.; 1935:61.

Note Type: Citation
Notes: Catalog 1922. New York: Foregger Company; 1922:47.

Note Type: Citation
Notes: Foregger anesthesia equipment: airways & intubation accessories [company product descriptions]. [Allentown, Pennsylvania]: Air Products and Chemicals, Inc.; 1975. [Lumbard-Miller Airway is not available.]

Note Type: Citation
Notes: Miller, Albert H., 1872-1959 [biographical file]. Archives. Located at: Located at: Wood Library-Museum of Anesthesiology, Schaumburg, Illinois.

Note Type: Citation
Notes: Liguori EC, Hargett MJ, Liguori GA. Thomas Linwood Bennett, MD: one of New York City’s first prominent physician anesthetists. Anesth Analg. 2013;117(4):1003-1009. http://journals.lww.com/anesthesia-analgesia/Fulltext/2013/10000/Thomas_Linwood_Bennett,_MD___One_of_New_York.29.aspx. Accessed February 5, 2015.

Note Type: Citation
Notes: Lumbard JE. A controller of the tongue and palate during general anesthesia. JAMA. May 22, 1915;64(21):1757.https://books.google.com/books?id=yQBBAQAAMAAJ&printsec=frontcover#v=onepage&q&f=false. Accessed February 4, 2015.

Note Type: Citation
Notes: On airways: in memory of Dr. Joseph E. Lumbard [Foregger Company advertisement]. Anesthesiology. 1943;4(1):i-ii.

Note Type: Citation
Notes: Providence anesthesiologists: our history. Providence Anesthesiologists website. http://www.providenceanesthesiologists.com/. Accessed February 5, 2015.

Note Type: Physical Description
Notes: One oropharyngeal airway; Consists of two rows of three parallel curved wires; The wires are held together by three metal crossbands; The crossbands are located at the distal end (based on the patient’s perspective) and near each end; The crossband near the distal end (again, based on patient’s perspective) is located about 3 cm from that end; The crossband near the proximal end is located about .8 cm from that end; The distal end is blunt while the wires at the proximal end have been bent to curve around to form a rounded end; A manufacturer marking is located on the distal end: “FOREGGER”; Hand engraved on the distal end is the text, “WOOD”.
Note Type: Reproduction
Notes: Photographed by Mr. Steve Donisch, September 18, 2013 with a Lumbard Airway (SydneyPlus Key akxa).

Note Type: Historical
Notes: An oral, or oropharyngeal, airway is placed in the mouth so that one end opens just outside of the patient’s lips, and the other end opens deep in the throat. When a patient is unconscious during anesthesia, an oral airway prevents breathing from becoming obstructed (as can occur with snoring or sleep apnea).

In 1915, Dr. Joseph Edward Lumbard (1865-1942) introduced a wire oral airway after finding that the solid walled airways, such as the Hewitt or Connell, could become obstructed with mucous.

According to a Foregger Company advertisement, Dr. Albert H. Miller (1872-1959) suggested rounding the pharyngeal end of the Lumbard Airway in 1918. The “Miller Modification of the Lumbard Airway” was available in the Foregger Catalog by 1922, and it quickly became a popular option for airway management. Foregger later renamed it the “Lumbard Airway—Miller Modification.”

Dr. Albert H. Miller is a lesser-known pioneer in the history of anesthesiology. His mentors included Dr. Thomas L. Bennet, an early physician anesthetist who practiced in New York City. In 1901, Dr. Miller became the first appointed physician anesthesiologist to the Rhode Island Hospital. In a short time, he organized a number of anesthesia services at other Providence hospitals as well. One of his policies included the use of anesthesia records for follow up and practice improvement. Because of A. H. Miller, Rhode Island Hospital may have been the first hospital in the U.S. to routinely use anesthesia records and employ their collective data to better patient care. Dr. A. H. Miller led the Department of Anesthesia at Rhode Island Hospital when it opened its anesthesia residency program in 1935. Among the residents to enter his program where Dr. Leo V. Hand (1903-1989) and Dr. Meyer Saklad (1901-1979). Dr. Miller was active in a number of local and national professional organizations, and authored more than 70 publications on a wide range of subjects. A sampling of article titles includes, “Ascending Respiratory Paralysis Under General Anesthesia”, “Blood Pressure in Operative Surgery”, and “The Role of Diaphragmatic Breathing in Anesthesia and a Pneumographic Method of Recording”.

Note Type: Exhibition
Notes: Selected for the WLM website.