Squire's Ether Anaesthetic Apparatus mark I 1846
Readers should also refer to the text and pictures of Hooper's Ether Inhaler 1846 on this web site.
This original Squire mark I ether inhaler was found in the basement of an old London Pharmacy in the summer of 2014. It is clearly based on a Nooth's apparatus minus the centre section and uses a ground glass stopper at the top, exactly the same as used on the original Nooths. It is fitted with a Read's flexible inhaler tube. The upper end of the tube that fits into the bottom glass section contains the ball valve and the lower 'mouth section' is fitted with an expiratory valve made in bone and a rotatable brass ring with a round hole which acts as a variable air inlet. At the end is a very crude inflexible mouthpiece made of wood. (The later Squire mark II used a leather mouthpiece which being pliable was able to fit the patient's mouth in a more satisfactory manner). It is signed Squire Oxford Street London etched on the lower glass vessel.
Close examination of the ground glass joints shows them to be in mint condition which means that the inhaler has never been used to hold ether, because if it had ever contained any there would inevitably be some deposits left on them. If on the other hand this apparatus had been made from an old Nooth's apparatus subsequently converted to anaesthesia, the deposits on the ground glass would assuredly have been even more pronounced. The lack of any signs of a deposit would appear to prove beyond any reasonable doubt that this apparatus was made specifically as an ether inhaler very shortly after the 21 December 1846. The fact that this apparatus is in mint condition because it was never sold is not really surprising considering the repeated failures of the Squire mark I following Liston's first successful capital operation and its quick replacement by the 'improved' Squire's mark II in the second week of January 1847. The fact that it has remained in the same pharmacy for the past one hundred and sixty-seven years until this summer provides a full unbroken provenance.
Condition mint and perfect. Base diameter 10” (25.5 cm) height 13.75” (35 cm)
It was astonishing to find this Squire's mark 1 because logically it shouldn't exist! After the success of the operation on Frederick Churchill it failed on every subsequent occasion when it was used. This was because the ball and socket valve used in Read's flexible inhaler failed to close properly unless the patient breathed out very strongly, otherwise the patient's expired breath re-entered the bottom chamber thereby diluting the ether vapour and thus failing to produce anaesthesia. Mr Robinson had also used Read's flexible inhaler in his Hooper mark 1 which was successful in the case of Miss Lonsdale (for a tooth extraction on19 December 1846) but which failed too in subsequent use. Dr Boott observed that Miss Lonsdale, “breathed out strongly”. Presumably Mr Churchill (see below) also “breathed out strongly” though this is not recorded.
The page numbers listed below refer to the paper Evolution of the First Anaesthetic Apparatus in Great Britain 17 December 1846 – 23 January 1847. All references to the original papers and journals are listed in date order in this paper after the introduction and acknowledgements. The references at the end of this condensed history.
17 December 1846 Dr Boott at his London home in Gower Street receives a personal letter from Professor Jacob Bigelow writing from Boston, USA enclosing an article by his son Henry, published in the Boston Daily Advertiser, giving details of the anaesthetic properties of ether. He contacts James Robinson, a dentist, also working in Gower Street and writes to Robert Liston, Professor of Clinical surgery at UCH and the medical journal The Lancet with copies of the letter and article.
19 December 1846 Mr Robinson had successfully anaesthetised Miss Lonsdale (using his “hastily got up” ether inhaler made from the bottom section of a Nooth's apparatus filled with sponges soaked in ether and a Read flexible inhaling tube - the Robinson mark I (page 2) in Dr Boott's study and removed her “firmly fixed molar”.
20 December 1846 Professor Robert Liston and his student William Squire visited Mr Robinson and Dr Boott. where they both saw and discussed the Robinson mark I inhaler after it failed to anaesthetise several patients, but they knew that ether had worked in the USA from Professor Bigelow's original letter and that Robinson's mark I inhaler had worked on the previous day. They also knew from Mr Robinson that he had made his ether inhaler from the bottom section of a Nooth's apparatus. When they left they went immediately to Oxford Street to meet William's uncle Peter Squire at his pharmacy to ask him to construct an ether inhaler. It was therefore no coincidence that Peter Squire also used another Nooth's apparatus and a Read's flexible inhaling tube to construct his first Squire mark I ether inhaler. But instead of using only the bottom section, he put the sponges soaked in ether in a top section which he then inserted directly in to the bottom section. This allowed the heavy ether vapour alone to descend into bottom section from which it was inhaled. It was an improvement on Robinson's first mark I ether inhaler which was copied by Robinson in his final Robinson mark III known subsequently as the “Hooper” ether inhaler. The Squire mark I was later described by Peter Squire as “temporary apparatus, which I hastily put together for Mr Liston” (page 6)
It was immediately tested on William Squire and some of the shop assistants and apparently worked. After the success of these experiments Robert Liston sent invitations by messenger round London inviting eminent doctors, surgeons and medical journalists to attend an operation (the amputation of Frederick Churchill's leg), the following day.
21 December 1846
At University College Hospital Professor Robert Liston amputates Frederick Churchill's leg after he breathed ether vapour delivered by the Squire mark I operated by William Squire in the presence of numerous important witnesses. The operation was a success. Churchill's leg was removed in twenty-five seconds according to the operation notes, with the patient fully anaesthetised and insensible to pain - see scan of part of the original operation notes.
As a result of the success of his Squire mark I in a major surgical operation, Peter Squire was keen to establish some sort of priority in the medical world over his rival Mr Robinson who was also interested in promoting his Robinson mark I ether inhaler. Using his position as the President of the Pharmaceutical Society, Peter Squire added a description and illustration of his Squire mark I ether inhaler at the end of the minutes of the 7 December 1846 meeting of the Pharmaceutical Society before the proofs went for printing. Since the published minutes of this meeting were dated ten days before the original letter from the USA announcing the discovery of ether anaesthesia was received by Dr Boott in London and fourteen days before Robert Liston operated on Frederick Churchill using his ether inhaler, it is perhaps not surprising that the knowledge and construction of the Squire mark I was previously missed by Barbara Duncum and others researching the origins of anaesthesia in Great Britain.
The omission of the Squire mark I from previous histories and the substitution of the Squire mark II as the presumed original anaesthetic apparatus was given further credence by the inclusion of the Squire mark II in the famous, now lost, painting (painted in 1910) produced subsequently of Professor Liston's historic first capital operation using anaesthesia, (pages 5 & 6 for a photograph of the painting and explanation).
From the minutes of the Pharmaceutical Society 9 December 1846
Peter Squire acted immediately to promote his inhaler and must have had a small number made by a local glass works engraved with his name and business address, which he then supplied to one or more pharmacies in the London area that could also provide the ether.
The original Squire mark I, after its success on the 21 December, subsequently failed in use on almost all occasions subsequently (pages 7 - 10). Accordingly, sometime between the 9th and the 13th of January 1847 Peter Squire produced his 'improved' ether inhaler - the Squire mark II with a metal top incorporating a side valve air inlet (see page 10). He described and showed it to the meeting of the Pharmaceutical Society on 13 January which was also attended by Mr Robinson. Peter Squire spoke first. His talk was followed by Mr Robinson who exhibited his latest ether inhaler, the Robinson mark III first made on 28 December 1846 subsequently known as the “Hooper”. There then followed a row between the two noted in the Society's minutes “concerning priority of invention, caveats, patents, registration &c.” (page 10).
The line drawing above of the Squire mark I reproduced from the minutes of the Pharmaceutical Society 9 December 1846, shows the top and bottom sections of a Nooth but with a conical lid on the top which was not part of an original Nooth. This would originally have been just a plain glass stopper. There are two alternative explanations for this. Assuming that the drawing is factually correct it is likely that the original stopper was missing and the conical cover (typically used on some of the standard glass pharmacy jars of the time), was used as a quick instant replacement. An alternative explanation is that the person who drew the picture simply got this feature wrong, but since it didn't make any difference to the functioning of the apparatus and because Peter Squire needed to get his article added to the Pharmaceutical Society's minutes before they were printed he let it pass rather than having it redrawn to correct what to him would have seemed at the time an insignificant error.
It is very doubtful if even half a dozen Squire mark I ether inhalers were ever manufactured given its extremely brief shelf life and additionally there would be very few pharmacies at that early date which stocked and sold ether. To date this is the only known verified example and it is in all probability a unique survivor.
There are three Squire's mark II ether inhalers in public collections: one in the Science Museum and one in the Wellcome Museum of the History of Medicine. Both are listed as copies. The third is owned by the Edinburgh Dental Museum which is a signed original.
The Squire mark I (and the subsequent Squire mark II), were both based on the design of Nooth's Apparatus with the centre section removed. Apart from the first original Squire mark I used on Frederick Churchill, all subsequent Squire ether inhalers both mark I and II were certainly made from scratch as surviving Nooth's Apparatuses would have been rare by 1846 and it would have been cheaper, faster and simpler to make new glassware.
The Squire mark II proved to be almost as useless and ineffective as the Squire mark I because it continued to use the faulty ball valve quickly identified by Dr Boott in December as the reason for the repeated failure of the Hooper mark I. Mr Robinson replaced it with the far more sensitive and reliable flap valves creating the Hooper mark II on 24 December 1846. Four days later on 28 December, Mr Robinson added a second chamber creating his final version the Hooper mark III which bore a strong outward appearance to the Squire mark II but was far more reliable due to the (hidden) flap valves. However both the Squire mark II and the Hooper mark III suffered from another major defect. They were made of glass which is a poor conductor of heat. As the ether vapour was inhaled and replenished by new ether vapour the internal temperature of both apparatuses dropped rapidly thereby reducing the density of ether vapour which was subsequently inhaled .
On 23 January 1847 Dr Snow introduced his all metal ether inhaler used in conjunction with a water bath at a determined temperature to adjust the proportion of ether vapour to air administered to the patient.
The Hooper and the Squire's mark I on this web site are the only two complete anaesthetic apparatuses dating from 1846 known to have survived. There are two earlier examples of the Morton ether inhaler in the USA but both are incomplete.
Early Anaesthetics Reference Index
- 1846 December 18 London Medical Gazette p. 1085-1086
- 1846 December 21 Dr Boott’s letter to The Lancet
- 1846 December 21 – February 11 Operation notes for Frederick Churchill surgeon Robert Liston. UCL library (special collections).
- 1846 December 22 – (January issue) The British and foreign Medical review p 308-312
- 1846 December 26 The Medical Times p. 251
- 1846 December 26 The Lancet p. 704
- 1846 December Transactions of the Pharmaceutical Society date published? P 337-338
- 1847 January 1 London Medical Gazette p. 38-39
- 1847 January 2 The Medical Time1s p. 271-273
- 1847 January 2 The Lancet p. 5-8, 16-17
- 1847 January 7 The Morning Chronicle report from Dublin Freeman’s Journal
- 1847 January 9 The Illustrated London News p. 30
- 1847 January 9 The Medical Times p. 289-294
- 1847 January 9 The Lancet p 49-51, 54
- 1847 January 13 Transactions of the Pharmaceutical Society p. 350-359
- 1847 January 16 The Medical Times p. 310-312
- 1847 January 16 The Lancet p. 73-80
- 1847 January 22 London Medical Gazette p.166-169
- 1847 January 23 The Medical Times p. 324-325
- 1847 January 23 The Lancet p. 104-107
- 1847 January 30 The Lancet p. 120-121
- 1847 February 24 Notes on the Inhalation of Sulphuric Ether in the Practice of Midwifery by James Simpson
- 1847 February 24? A Treatise on the Inhalation of Sulphuric Ether for the Prevention of Pain in Surgical Operations by James Robinson
- 1847 March 26 April issue London Medical Gazette p. 547-576
- 1847 February 27 The Medical Times advert James Robinson’s Treatise and Squire’s Apparatus
- 1847 April Edinburgh Medical and Surgical Journal p. 504-519
- 1847 April? Painting of Robert Liston’s historic operation the amputation of the leg of Frederick Churchill 21 December 1846
- 1888 December 22 The Lancet p. 1220-1221
- 1893 Dictionary of National Biography Francis Boott p. 293
- 1893 Dictionary of National Biography Robert Liston p. 357-35831 Nooth’s Apparatus invented in 1777 for the production of soda water, examples in the Science Museum, National Museums of Scotland, Penshurst House and three others recorded in other museums.32 Barbara M. Duncum, The Development of Inhalation Anaesthesia. OUP 194733 Early Technology, Monkton House, Old Craighall, Musselburgh. EH21 8SF34 Royal College of Surgeons, Edinburgh35 1916 January 15 The Lancet obituary p. 157-16136 Royal College of Surgeons, Edinburgh.
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