Anaesthesia apparatus: Hooper's Ether
Inhaler, 1846Anaesthesia apparatus: Hooper's Ether
Inhaler, 1846Hooper's Ether Inhaler made in late December 1846 was the world's earliest anaesthetic apparatus that functioned reliably with repeatable success. This claim was made by James Robinson (see below) in his "A Treatise on the Inhalation of Sulphuric Ether for the Prevention of Pain in Surgical Operations" published on 24 February 1847. After reading every contemporary text in the medical journals that I could find and articles in the daily and weekly press of the period I am convinced that all the available evidence supports this claim. (I actually used seven libraries in total, five medical and two general, to look up all the original papers and written accounts of the first operations carried out in Europe and America using ether in latter part of 1846 and January 1847. What follows is necessarily a brief summery without the original references, but on request I can email the full paper I have written as a result of this work. In my innocence I assumed that probably no subject was as well researched as the beginnings of anaesthesia - arguably amongst the greatest of medical discoveries, but the more I read the more I discovered that the accounts given in medical history books were flaky or just plain wrong, when detailing the history of the development of the first truly practical anaesthetic apparatus in the world).
On 30 September 1846 Dr Morton used an ether saturated handkerchief to successfully anaesthetise Eben H. Frost and extract a tooth without pain. Subsequent attempts proved to be failures and the first glass apparatuses constructed soon after that first successful case also failed much of the time. Successful anaesthesia was until the end of 1846 a very hit and miss proceedure with more failures than successes. The first successful use of glass apparatus (made by Chamberlain), was at Massachusetts General Hospital in the USA on 16 October 1846 in an operation on a tumour on the neck of a patient. The first amputation successfully performed under ether anaesthetic was on 21 November also in the US. The glass apparatus was still far from reliable but the principle of inhaling ether vapour to produce insensibility had by then been proved. Moreton's glass ether inhaler was described in the Boston Daily Advertiser:
"A small two-necked glass globe contains the prepared vapour, together with sponges, to enlarge the evaporating surface. One aperture admits the air into the globe, whence, charged with vapour, it is drawn through the second into the lungs. The inspired air this passes through the bottle, but expiration is diverted by a valve in the mouth-piece, and escaping into the appartment is thus prevented from vitiating the medicated vapour."
On 17 December 1846 Dr Boott in London received a personal letter from Dr
Bigelow in Boston, USA enclosing an article published in the Boston Daily
Advertiser giving details of a paper by his son Henry Bigelow about the
anaesthetic properties of ether. Dr Boott contacted his neighbour, a surgeon
dentist, Mr James Robinson and forwarded the US news to the medical journal
The Lancet the same day. On 19 December James Robinson using "a very
imperfect apparatus hastily got up"
removed 'a firmly fixed molar'
in Dr Boott's study from a Miss Lonsdale (glass apparatus used "Robinson Mark
I"). This was the first successful operation carried out under general
anaesthetic in Europe. On the following day 20 December 1846 Mr Robinson and
Dr Boott tried again on several other patients in the presence of the most
famous general surgeon of the day Robert Liston and his assistant, a medical
student, William Squire but all attempts at producing insensibility failed on
this occasion. The ball and socket valve used in the inhalation tube was
blamed as it didn't close sufficiently well to prevent the expired air from
re-entering the glass ether apparatus and thereby diluting the ether vapour.
Robert Liston contacted his student's uncle an eminent pharmacist and
president of the Pharmaceutical Society, Mr Peter Squire to make up another
apparatus. Peter Squire described it thus: "temporary apparatus which I
hastily put together for Mr Liston"
, (glass apparatus: Squire's mark I).
On 21 December 1846 at University College Hospital, London in the presence of
a large invited audience Mr Liston amputated the leg of Mr Frederick
Churchill under ether anaesthetic in 25 seconds! - (original operation notes
are reproduced in my paper along with illustrations of all the different
anaesthetic apparatuses mentioned here). A second successful operation
followed and the word spread instantly. Over the following days the "Squire's
mark I" failed to produce insensibility when used subsequently. On 24
December Robinson modified his first apparatus - the ball and socket valve
being replaced by a flap valve, (glass apparatus: Robinson mark II) - and
assisted the surgeon Mr Ferguson at King's College Hospital, London, in three
operations in succession. In all three cases successful anaesthesia was
achieved. Over the following days more successes and failures were reported
in the medical press.
28 December 1846 Mr Robinson performs two dental extractions under full
ether anaesthetic, a child of 12 years and a young man - "having another
apparatus constructed.....a description of which shall be given
hereafter."
(glass apparatus: first use of the "Hooper" so called in the
literature after the manufacturer who made it to Robinson's specification.
This was in effect the Robinson mark III). I attach an engraving of the
Hooper published on 9 January 1847 in the Illustrated London News.
31 December 1846 Mr Liston attempts the amputation of the forearm with the assistance of Mr Squire's Apparatus - fails again to produce insensibility.
4 January 1847 "On Monday at University College Hospital an
extraordinary scene occurred. A woman, it appears was to have a tumour of the
breast removed by Mr Liston. After inhaling the vapour of ether for upwards
of twenty minutes without any sensible effect, the operation was performed
with the usual accompaniment of severe pain, (another Squire's mark I
failure). After this, a woman was operated on for partial closure of the
mouth. Mr Robinson superintended the inhalation of vapour, using his own
apparatus; the patient became perfectly insensible after two minutes and the
operation completed..."
report from The Medical Times.(apparatus used
Hooper's Inhaler). Sometime after this but before the meeting of the
Pharmaceutical Society meeting of 13 January 1847 Peter Squire manufactured
his Squire's mark II ether inhaler (glass apparatus illustrated) which was
remarkably similar to the successful Hooper's Inhaler. By the end of January
1846 Dr Snow had published his table of ether saturated air at different
temperatures and the first all metal ether inhaler with a warm water jacket
was invented as well as several other glass apparatuses by competing
manufacturers. On or about 24 February 1846 James Robinson published his
"A Treatise on the Inhalation of Sulphuric Ether for the Prevention of
Pain in Surgical Operations." By this time hundreds of successful
operations had been carried out in thirty-three hospitals throughout the UK,
plus some operations on animals in three veterinary practices. In his paper
James Robinson makes the following claim.
"I will now describe the apparatus before referred to (the Hooper) ...Alterations and improvements will no doubt be made in its details, but its principle will be retained; at all events it is the first apparatus of its kind to be employed with general success"
(my itallics). The contemporary record seems to fully justify this claim.
The Hooper's Ether Inhaler offered here for sale seemed to me at first sight very odd. There were several 'problems'. First the box in which it is fitted is typically Georgian in style - larger, but similar to microscope boxes of the late eighteenth century - certainly not dating from the late 1840s. Secondly the contents fitted very awkwardly. The flexible tube was too long to fit properly and the mounting of the brass valve assembly on the front was very odd to say the least. Thirdly there was no fitted space for the mouthpiece or other small parts - they simply sat loosely on the lower shelf. Finally it was obvious that the box had been very crudely adapted to fit the items inside in the first place. The shelves had been roughly cut out to hold the flexible tube and part of the door had been gouged out to enable it to shut with the valve assembly in place with no attempt made to finish off the cuts neatly. The historic record specifically states in several contemporary accounts that the first Hooper was made from a modified Nooth's Apparatus. Nooth's Apparatus was invented in the 1770s for the production of soda water (see illustration). In the 1790s Schweppes opened their first factory in London for the commercial manufacture of soda water and Nooth's Apparatuses became effectively redundant.
By the late 1840s Nooth's Apparatuses were fifty years old or more and any surviving examples would of course be in Georgian carrying cases. Once this fact is realised all the problems listed above make sense. I attach a photo showing the stripped down Hooper in its case. Note the 'spare space' at the top of the box. When the contents were in their original form as a Nooth's apparatus this space would have been taken up with a small glass reservoir to hold some water that was required to produce the pressure below for soda water to form, the carbon dioxide being made by the interaction of acid and marble. I attach a further image where I have drawn in the missing parts which convert the Hooper back to its original state as a Nooth's Apparatus. The modifications to turn it into a Hooper's Ether Inhaler explain why everything is so cramped and why there is space left to fit the extra parts. Finally the unfinished nature of the woodwork modifications needs an explanation; Victorian workmanship was never thus in England.
Returning to the historical record James Robinson was a man on a mission. He made his first prototype ether inhaler the day after reading Dr Bigalow's letter and used it on Miss Lonsdale the following day. He modified the apparatus and had his mark II ready for trials five days later and modified it again for further trials four days later - producing his mark III, the Hooper on 28 December 1846. During this time he was also writing daily to the medical press giving not only results of operations that he participated in, but also reports from other surgeons and answering questions on ethics and practical problems. In this same period Robinson demonstrated anaesthesia in several different London hospitals to large audiences of surgeons and doctors. He was a man in a hurry. Getting the modified apparatus 'into the field' as quickly as possible was his priority and the niceties of finishing off the woodwork were irrelevant to him compared to developing and demonstrating the first truly practical anaesthetic apparatus before anyone else. Hours, even minutes saved were important. The crudely finished woodwork modifications bear elegant historic testimony to this frenetic period as surely as any written record. One other feature points to this apparatus being the first prototype Hooper. The mouthpiece is made of wood with a rim of leather. (Incidentally it must have been turned using an elliptical chuck on an ornamental turning lathe). One of the first subsequent improvements made to the Hooper and recorded in early January 1847 was to make the mouthpiece flexible - to fit different faces - the elliptical wood mouthpiece was replaced by a flexible leather mouthpiece.
This Hooper was owned by Sir Frederic William Hewitt anaesthetist to King Edward VII, the most famous anaesthetist in Britain and probably the world before he died - thence bought by Early Technology from his grandson. I attach a copy of his photograph from his obituary in The Lancet.
I believe there are two Morton glass inhalers (single glass flasks with two necks) preserved in institutions in the US that just pre-date this Hooper's Apparatus. It is certainly the earliest anaesthetic apparatus outside the US and I am equally certain nothing as early (or earlier) pertaining to anaesthetics has ever been offered for sale previously on the open market. This is a unique opportunity to acquire one of the most important medical artefacts ever to be offered for sale. In fact it is difficult to think of a more important medical artefact that could be offered for sale!
Case near perfect, original key, door slightly warped. Hooper glassware perfect, inhaling tube still flexible, most original lacquer present on the brass valve assembly. Valves in good working order. Wood mouthpiece plus leather edging perfect. Size of case: Height excluding handle 17.75" (45.0 cm) width 9.9" (25.2 cm) depth 10.9" (27.7 cm) Other photos or larger images emailed on request to serious enquiries. Questions answered by email. Transport and insurance at cost to be arranged with buyer.