Magill Expiratory Valve

WLMD ID: apod
The influential British anesthesiologist, Sir Ivan Whiteside Magill (1888-1986) was a leading practitioner, inventor and advocate for professionalism. From 1919 to 1923, he worked together with his colleague Dr. Sidney Rowbotham (1890-1979) at Queen's Hospital for Facial and Jaw Injuries in London. The two men collaborated on several inventions and improved the techniques of endotracheal anesthesia. Magill called one of these inventions "the two-tube method", in which one endotracheal tube carried air and anesthetic vapors to the patient while a second tube, equipped with a spring-loaded expiratory valve, carried away the patient's exhaled breath. This was an advantage in the time period before circle breathing systems, with carbon dioxide absorption, were widely available. The valve, known as the Magill Attachment, was also a component of the Magill Insufflation Apparatus and the Magill Anesthesia Machine, both made by the London manufacturer, A. Charles King. In these, the valve was positioned between the mask and the breathing hose. The example of the valve seen here was made by King, probably between 1920 and 1940.

Catalog Record: Magill Expiratory Valve Magill Valve

Access Key: apod

Accession No.: 2005-11-13-3

Title: [Magill attachment] / A C King Ltd.

Author: Magill, Ivan W. (Whiteside), 1888-1986.

Corporate Author: A C King Ltd.

Title variation: Alt Title
Title: Magill adapter.

Title variation: Alt Title
Title: Magill connector.

Title variation: Alt Title
Title: Magill expiratory valve.

Title variation: Alt Title
Title: Magill spring-loaded valve.

Publisher: London : A. Charles King, [not earlier than 1919 and not later than 1950].

Physical Description: 1 expiratory valve : metals, rubber ; 4.75 x 6.5 x 3 cm.

Subject: Anesthesia, Inhalation – instrumentation.
Subject: Nonrebreathing Valves.

Web Link: https://www.woodlibrarymuseum.org/museum/item/1072/magill-expiratory-valve

Note Type: General
Notes: The first year in the date range is the year that Magill began working with Rowbotham at Queen’s Hospital in Sidcup. The second year in the date range is based on the approximate date of a British Oxygen Company catalog which does not include King apparatus.

The front of the object is considered that side which is intended to be attached to a mask, while the back is considered that side which is intended to be attached to a breathing hose.

Note Type: Citation
Notes: Allen & Hanburys. A Reference List of Surgical Instruments and Medical Appliances, Orthopaedic and Deformity Apparatus, Hospital Furniture and Equipment, Electro-Medical and Surgical Apparatus, etc. London: Allen & Hanburys Ltd., 1930:48.

Note Type: Citation
Notes: Bowes JB, Zorab JSM. Sir Ivan Magill’s contribution to anaesthesia. In: Rupreht et al., eds., Anaesthesia: Essays on History. Berlin: Springer-Verlag, 1985:13-17.

Note Type: Citation
Notes: Sir Ivan Magill [Obituary]. Br Med J (Clin Res Ed) 1987;294:62-63.

Note Type: Citation
Notes: British Oxygen Co. Anaesthetic apparatus, section A. Wembley, Middlesex: The British Oxygen Co. Ltd., Medical Section, ca. 1950-1955.

Note Type: Citation
Notes: Dinnick OP. The ‘Magill attachment’. Proceedings of the History of Anaesthesia Society. 1991;10:33-37.

Note Type: Citation
Notes: Down Brothers. A Catalogue of Surgical Instruments and Appliances with Appendix, Including a Large Number of Original Designs Manufactured and Sold by Down Bros., Ltd. London: Down Brothers., Ltd., 1929.

Note Type: Citation
Notes: Lee JA. A Synopsis of Anaesthesia. Bristol: John Wright & Sons, Ltd., 1947:72.

Note Type: Citation
Notes: Magill IW. A portable apparatus for tracheal insufflation anaesthesia. Lancet. April 30, 1921;197(5096):918.

Note Type: Citation
Notes: Magill IW. Endotracheal anesthesia. Anes Analg. March-April, 1929;8(2):28-32.

Note Type: Citation
Notes: Magill, I. W. Technique in endotracheal anaesthesia. BMJ. November 15, 1930;2(3645):817-819.

Note Type: Citation
Notes: Micklem NJ, Jones CS. Partial pressure of oxygen in the Magill attachment.” BJA. November, 1957;29(11):491-494.

Note Type: Citation
Notes: Nosworthy MD. The Theory and Practice of Anaesthesia. London: Hutchinson Scientific, 1935:117-119.

Note Type: Citation
Notes: Ward CS. Anaesthetic Equipment: Physical Principles and Maintenance, 2nd ed. London: Bailiere Tindall, 1985:141.

Note Type: Citation
Notes: Wilkinson DJ. A. Charles King: a unique contribution to anesthesia. J Royal Soc Med. August, 1987;80(8):510-514.

Note Type: Physical Description
Notes: One expiratory valve; Consists of a T-shaped tube with a spring-loaded valve in the short arm of the T; Both the long and short arms of the T are approximately 2 centimeters in diameter; The long arm has striations at the back end, extending approximately 1.5 centimeters inward from that end; The short arm of the T is mounted off-center, closer to the back end; The valve in the short arm has three rectangular openings, approximately 1 centimeter long each, that are evenly spaced around its circumference; The spring in the valve is controlled by a screw; The spring is attached to the interior end of the screw; As the screw is turned downward, it presses the screw against a rubber disc that is loosely seated in the base of the valve; When the screw is in its lowest position, the height of the object is 4 centimeters; In this object, the screw has been bent and the knob on the screw appears to be seated at an angle; The knob is marked “A. CHARLES KING [new line] LONDON”.

Note Type: Reproduction
Notes: Photographed by Mr. Steve Donisch, November 15, 2016.

Note Type: Historical
Notes: The British anesthesiologist, Sir Ivan Whiteside Magill (1888-1986), was an influential figure in his specialty, leading as a practitioner, inventor and advocate for professionalism. From 1919 to 1923, he worked together with his colleague, Dr. Sidney Rowbotham (1890-1979), at Queen’s Hospital for Facial and Jaw Injuries at Sidcup, a suburb of London. The two men collaborated on several inventions and improved the techniques of endotracheal anesthesia.

An obituary of Magill which appeared in the British Journal of Medicine quotes extensively from his autobiographical statements, but does not provide references for them. In one of these, speaking of his work at Sidcup, he wrote: “Gilles, who was the surgeon at the time, said ‘You seem to get the anaesthetic into the patient alright – don’t you think that you could devise some method of getting it out so that I am not anaesthetized?’ So Rowbotham and I got to work on this and devised a two tube method of anaesthetics. We insufflated through a catheter in the trachea but in addition passed a second catheter to deal with expiration…. At the same time it was the origin of what is sometimes known as the ‘Magill attachment’ – I’ve never written it up in any way.” While Magill may not have introduced the attachment as separate invention, he did describe it in several publications. For example, in 1930, he noted that his apparatus was equipped with “a delicate spring expiratory valve”. This method of shunting away the patient’s exhaled breath was an advantage before circle breathing systems, with carbon dioxide absorption, were widely available.

In 1921, Magill introduced his insufflation anesthesia apparatus. While Magill’s own description of the apparatus does not mention the valve, it appears in textbook and catalog descriptions of that apparatus in the WLM collection, dating from 1928 to 1944. The valve was also a component of the Magill anesthesia machine, introduced ca. 1928. Both the Magill insufflation apparatus and the Magill machine were made by the London manufacturer, A. Charles King. King became a wholly owned subsidiary of British Oxygen Company in 1939, and some of its products were advertised as late as the mid-1950s.

The 1947 edition of Lee’s Synopsis provides two diagrams of the valve, but does not discuss it. These illustrations, made by A. Charles King, show the valve as being closed during inhalation, with the rubber disc firmly seated, and open during exhalation, with the patient’s exhaled breath lifting the disc upward and escaping through the vents in the valve. In both diagrams the screw appears to be turned down only half of its length. The cataloger found publications that specifically discuss the valve dated as late as 1991. All of the descriptions seen by the cataloger indicate that the valve was mounted between the mask and the hose. Various Illustrations show several different forms of the valve. According to Dinnick, the cataloged object represents a form that was made to fit with the corrugated rubber hoses that were introduced in 1931. Dinnick also states that the device was “almost certainly” given the name “Magill attachment” by A. Charles King. The device has been called a pressure-limiting valve, although that was not its original purpose.

Note Type: Publication
Notes: Magill IW. The provision for expiration in endotracheal insufflation anaesthesia. Lancet. July 14, 1923;202(5211):68-69.

Note Type: Publication
Notes: Magill IW. An apparatus for administration of nitrous oxide, oxygen and ether. Lancet. August 4, 1923; 202(5214):228.

Note Type: Publication
Notes: Magill IW. An expiratory attachment for endo-tracheal catheters. Lancet. June 28, 1924;203(5261):1320-1321.

Note Type: Publication
Notes: Magill IW. Improved anaesthetic apparatus. Lancet. August 20. 1927;210(5425):396.

Note Type: Publication
Notes: Magill IW. Endotracheal anaesthesia. Proceedings Royal Soc Med. 1928;22:83.

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