Anesthesia


AMBU-bag
Ambu 1
Ambu 1 Detail
Ambu 2
Ambu 2 Detail

Ambu 11
 

 

For manual ventilation of patients with respiratory arrest or insufficient breathing. comes since the 50s, a "resuscitator" used.

 



History
"The best-known manufacturer of the bags is the Danish company Ambu A / S, founded in 1937 by the German engineer Holger Hesse, with whom the Danish anesthesiologist Henning RUBEN (hence the name" Rubenbeutel ") developed the first respiratory bag in 1956, the" self- inflating resuscitator. "In 1951, after spending time abroad in Sweden and England, he spent half a year working with James Elam in Iowa, USA, where he became interested in ventilation and inventing inventions The strike of these truck drivers, who cut off hospitals from the supply of necessary material, was the trigger for the first self-expanding breathing bag for RUBEN in 1954. The device, initially assembled with the help of bicycle spokes, became the prototype of what the American Medical Association 196 4 described as one of the most important advances in anesthesia in the last 25 years "(Wikipedia).

 


The inventor
Henning Moritz RUBEN was born on 20.7.1914 in Copenhagen, the son of an Orthodox Jew. Originally trained as a dentist (graduated in 1933), he was astonished with a number of strange skills: tango dance, fencing and magic. From 1943 he studied medicine in Copenhagen, where he graduated in 1946. He was interested in anesthesia ... In the 1951 years he worked together with James Elam in Iowa, USA, after spending several stays abroad in Sweden and England for half a year. There began his interest in ventilation and his inventiveness of inventions. From 1955-1984 he was finally Professor of Anesthesia at the University of Copenhagen. He died on 4.12.2004.


 


Two bags that my wife brought along from the children's hospital in 1980.
1) Resuscitation bag Mark III 3 (black) with mask 5 with filter adapter
2) Silicone Pouch Professional (blue). The integrated hand strap allows the bag to grip even better.

Braun
Braun
Braun
Braun
Braun
Braun
Braun
Braun
Braun

Anesthesia


BRAUN apparatus

Braun 3
 

 

During his studies, Heinrich Friedrich Wilhelm BRAUN (1862-1934) performed in the surgical department under Prof. Carl Thiersch (1822-1895, surgeon in Leipzig) and - still a student - performed anesthesia. This experience developed with him the interest in anesthesia and its practical application.


Under the influence of a fatal accident with chloroform in the late 1890s, he dealt with so-called mixed anesthetics in which chloroform and ether were mixed: by combining 2 vapors, the dosage of each individual could be reduced and the likelihood of side effects reduced accordingly. Starting from the devices of Junker v. Langegg, von Kappeler and Hewitt BRAUN 1897 developed a handy device, which he gave the name "NARKO". In it a 150 ml ether and a 50 ml chloroform glass were combined and connected with hoses so that the gases could be mixed. Via a rubber balloon, a stream of air was passed over one or both vessels and led to the patient. When the taps were wide open, a gas mixture of 1% by volume of chloroform vapor and 4% by volume of ether vapor flowed out. The rubber tube blower with double balloon (pump ball with valve, blower ball with safety net) was borrowed from the micro hot air burner from Holländer. The device was presented at the 30th Congress of the German Society of Surgery on April 11, 1901 in Berlin - the Berlin Waarenhaus (catalog p.60, without illustration) offered it in 1910 for a proud 50 Reichsmark. There was the device with face mask, for the nasal and the pharyngeal application and for the operation with the foot. For the patients, it brought a hitherto unknown safety in anesthesia. This explains why the easy-to-use devices were in circulation until the 1940's, before they were finally replaced by the more complex (and heavier) oxygen anesthesia machines.

Production: the Leipzig medical device company C.G. Heynemann, Franz-Flemming-Strasse 23 produced the apparatus. Presumably, the copy presented here in the branch of the Fa. Schmeink in Antwerp was sold and therefore provided the lid of the mahogany box with the label of this company.



The device presented here has a moving past. It was given in 1990 to the anesthesiologist Prosper KAYSER by a Dutch colleague on the occasion of the 25th anniversary of the existence of an anesthetic department at the Zitha Clinic in Luxembourg. KAYSER passed it on to Museum SYBODO in August 2014. Special thanks for the generous gesture!

The Braun ether-chloroform vaporiser was very frequently used during the first fifty years of the 20th century, mainly in the German speaking region. This primacy was principally involved by the simple management, the universal possibilities of application and the "expedient" combination of ether and chloroform: this term means the differential employment of these two substances for conducting individual anaesthesia. Heinrich Braun had published his method after extensive experimental studies, here briefly referred to; further reasons for the considerable success of the apparatus are discussed.

 

Lit.:

- Brandt, Ludwig, Illustrierte Geschichte der Anästhesie, Wissenschaftliche Verlagsgesellschaft Stuttgart 1997 S.132.

- Braun, H., Ueber Mischnarkosen und deren rationelle Verwendung (pp.136-170, 4 Abb.), in: Verh. Dtsch. Ges. Chir., 30. - Berlin 1901, 8°, LXIV, 222, 800 pp., Abb., 7 z.T. farb. lith. Taf..

- Braun H., Ueber Mischnarkosen und deren rationelle Verwendung. Arch Klin Chir 1901; 64: 201-235.

- Goerig, Michael, Die Entwicklung des Narkosewesens in Deutschland, Steintor Verlag 2012 SS. 71-74.

- Kühn, Curt, Ueber 200 Narkosen mit dem Braun'schen Aether-Chloroformgemisch, 1903, 21 Seiten

- Narko: Apparat zur Aether-Chloroform-Mischnarkose nach Geh. Med.-Rat Prof. H. Braun; neues verbessertes Modell mit Luftstrom-Verteiler. C.G. Heynemann Fabrik Ärztlicher Instrumente, Verlag B . Georgi, 1902.

- Weisser C., The Braun apparatus for mixed ether-chloroform anesthesia. A contribution to the early history of combination anesthesia, in: Anaesthesist. 1983 Aug; 32(8):369-73.

Anesthesia


Chloroethyl (1)

abb91

Kelen, around 1940

 

 


"Le chlorure d'éthyle permit aussi bien l'anesthésie rapide par inhalation que l 'anesthésie locale par le froid." "Son évaporation sur la peau consommant une grande quantité de calories, le froid ainsi provoqué permet l'apparition d'un givre provenant de la vapeur d'eau de l'air ambiant; ce phénomène permet de juger le moment opportun pour une incision d'abcès par exemple! "

 


This local application of chloroethyl for cold anesthesia of the skin goes back to the Geneva doctor and dentist Camille REDARD (1841-1910), who reported in 1888 on the benefits of Chloraethylsprays in his practice.


The "Handbuch der neuen Arzneimittel" by J. MINDES from 1901 writes: "Ethylene chloratum, a local anesthetic that is well tolerated, is recommended by REDARD in Geneva for dental surgery and sciatica."
- still the drug did not prevail. However, the same plant already knew the KELEN-methyl, "a mixture of chloroethyl and chloromethyl" - chloromethyl was a substitute for chloroform.

 


The German-speaking clinicians also used the French product KELEN. For many years, this drug remained a popular remedy for the administration of prolonged anesthetics (which was then continued with ether or chloroform). Already at the beginning of the 20th century, however, the incidents increased in this procedure: quite unexpectedly 1 patient died on 2000 anesthesia under the condition of asphyxia or syncope. Despite the inherent risks, KELEN was used until after World War II before it had to give way to modern anesthetics.

Anesthesia


Chloroethyl (2)

abb94


 

A much used procedure for pain relief in small procedures was the "icing". For this purpose, volatile substances such as ether, chloroform and chloroethyl were used. RICHARDSON published in 1866 an etching device which allowed the skin to be rapidly cooled to -15 to -20 ° C by an air jet. Shortly afterwards, the German dentist Jean-Baptiste ROTTENSTEIN introduced chloroethyl for local anesthetics.



The chloroethyl of Fa. THILO probably corresponded to the KELEN.



The ophthalmological preparations of the house THILO were bought after the 2nd WK by the pharmaceutical giant "Alcon Pharma" and are further commercialized under the designation "Thilo" and "Thilodigon eye drops".

 

 

Presented is a bottle with an oblique outlet of the spray nozzle of Dr. med. THILO & Co.Chemische Fabrik, Mainz; around 1930.

Anesthesia


Chloroethyl (3)

abb727

from Dr. BENGUE 

 

"Chloréthyle du Dr. Bengue Bte S.G.D.G.
Anesthésie locale Névralgies
Dr. BENGUE, Pharmacien
47, Rue Blanche, Paris
(et Pharmacie MANNHARDT, 34 Rue Labruyère, Paris).

(bought on a flea market in Arlon on 6th of november 2005).

Anesthesia


Chloroethyl (4)

abb907
 

 

HIPPOCRATES mentioned in his books that he used ice and snow before he started his operations. Dominique Jean LARREY (1766-1842) was able to perform amputations on half-frozen soldiers in sub-zero temperatures - cold as an anesthetic has a long tradition. The cold anesthetic spray "Chloraethyl Dr. HENNING" in its 100 ml spray bottle with lever lock is exported worldwide. The spray bottle produces a targeted jet for selective treatment of small areas of the skin, for example for icing of warts, sports injuries (strains, bruises, sprains), swelling and muscle cramps.



label
Dr. Georg Friedrich HENNING
Chemical Factory, Inh. E. Wedel
6909 Walldorf / Baden.



The company based in Walldorf near Heidelberg has been producing for over 100 years. The address has since changed: postal code 69190.

 


Is this Henning identical to the following pharmacologist?
Hexogen was first manufactured in 1898 by the Berlin chemist and pharmaceutical entrepreneur Georg Friedrich Henning as an explosive for technical use and as a starting material for pharmaceutical preparations and described in the German Reich Patent under the number 104280 of 15 July 1898. H. Brunswig also recognized in Germany in 1916 the highly explosive properties and had them protected in two process patents. In 1920, they explored the substance in the Military Experimental Office in Berlin and called it now Hexogen.



Since 01.01.2004 CHLORAETHYL "DR. HENNING" is no longer subject to a pharmacy, but continues to be distributed exclusively by the manufacturer apothecary-exclusive.


Presented is a spray bottle with apicalem outlet of the spray nozzle.

Anesthesia


Chloroethyl (5)

abb90

Druckflaschen n. Dr. BENGUE

 

 

In 1895 a dentist noticed that not infrequently his patients fell asleep when he splashed chloroethyl (= chloroethane, chloraether) on their gums in order to locally stun them by icing. This narcotic effect was confirmed in many hospitals (Hildesheim, Zurich, Basel and Constance); The quick onset and fleeting sleep caused by chloroethyl was very well suited for brief interventions, especially since the odor of the preparation was much more pleasant than that of chloroform; Pulse and breathing were unaffected, the respiratory tract was not irritated, there was no excitation phase ...



How widespread the "Chloréthyle BENGUE" was, is proved by the following anecdote. A doctor reports on taking over a practice in SchwarzAfrika: "mon prédécesseur, à l'évidence oligopharmaque et paucithérapeute, ne disposait en tout et pour tout que de Baume Baissade et de Chloréthyle Bengué"
perso.orange.fr/jdtr/Painciel.htm

 

The Luxembourgish legislation knew in 1959 the general anesthetic with chloroethyl:
L'anesthésie locale au chloréthyle, les anesthésies par instillations, tamponnements et badigeonnages sont includes dans le prix de l'intervention.


13 ° Anesthésie générale:
1) de courte durée au chloréthyle ou à l'évipan, in parallel with the intervention in surgical and dental surgery
2) de durée prolongée à l'éther, au chloroforme, l'anesthésie continue par voie intraveineuse ou rectale, l'anesthésie combinée avec la curarisation, l'administration de ganglioplégiques, l'hibernation contrôlée artificielle "(Memorial n ° 31 of 2.7 .1959).
In this indication, the chloroethyl is due to the difficult Dosierbarkeit u. The dangerously small anesthesia range is no longer used today, but it is for local icing.



After Dr. BENGUE is a chloraethyl bottle, which was exhibited at the Palais des Congrès in September 1999 as part of an exhibition entitled "Matériel ancien d'Anesthésie et de Réanimation".



The Parisian pharmacist Jules BENGUE (1840-1898) had developed a locally cooling ointment in the late 19th century against muscle strains consisting of menthol, salicylate and lanolin, the "Ben-Gay" - a hit in the US market.

Anesthesia


Chloroform, drips

abb95

um 1950 

 

 

Chloroform was dripped onto the mask by means of handy drip-bottles - well evenly, about every 2 seconds a drop was dropped.

Two of these dripdrops, as they call the Americans, are presented here. To the left of it a large round chloroform transport bottle.



An early witness
"Not a year ago, says the" Berl. Z.-H. " that the sulphate ether fills the world with the cry of its pain-relieving power, when a new dangerous rival arises again, which threatens to chase it away from the easily conquered terrain. Today we were the witnesses of one with the help of chloroform in the local (Berlin) Charité von Hrn. Go. N. Jüngken's amputation of the lower leg, and had the pleasure of feeling numb to the patient during the whole lengthy operation, and to see them completely awake at the time of awakening. The fame of the first application of the new product, which incidentally was invented by Leibig and represented by the distillation of sulfuric ether with chlorinated lime, belongs to Professor Simpson in Edinburgh, who has been brimming with success for many months in various operations and also in the birth-aid second hand. The advantages afforded by chloroform over the ether are its more rapid action, which is less than two minutes in duration, quite pleasant, with a much more agreeable odor, much less quantity needed for anesthesia, and a lack of anesthetics Aftermath on the brain, respiratory and digestive organs "(Diekircher Wochenblatt, 11.12.1847).

Anesthesia


Chloroform mask (1)

abb86

Mask from ESMARCH

 

 

The pleasant smell and less mucous membrane irritation of the chloroform immediately caused a wide distribution of this anesthetic, which proved particularly useful in obstetrics. Even VELPEAU in France, who in 1840 had said "éviter la douleur dans les opérations est une chimère qu'il n'est pas permis de poursuivre aujourd'hui", had himself converted to the new procedure. In 1853, for example, the English Queen Victoria was released in chloroform intoxication - the "anesthesia à la reine" became the hit of high society.



Several methods competed to apply the chloroform:
- the sponge, which was pressed directly on the nose,
- The 1862 specified mask of the birthing aid Thomas SKINNER from Liverpool, which was covered with gauze
- the 1877 mask of A. von ESMARCH.

 


"The Esmarch mask is, in principle, a wire mask covered with a cloth, a construction that modified and improved the mask of the Englishman Thomas SKINNER as early as 1862. By dropping chloroform on the fabric, the anesthetic volatilized and could now be vaporized as vapor A significant improvement over the previous method of chloroform pouring on a cloth or sponge, which was pressed directly to the patient's mouth and nose, with the dropwise application of the chloroform to the mask the considerably better dosability of the anesthetic, for mixing with a lot of fresh air and thereby to a drastic reduction of the risk of hypoxia "(Wolfgang Regal).

 



The mask presented here served for many years our colleague dr. Emil GRETSCH (1908-2004) "anaesthésie à la reine" for births at Maternité Charlotte.

Anesthesia


Chloroform mask (2)

abb88
Ledertasche n. ESMARCH 

 

"In the last quarter of 1846, it was used to provide general anesthesia for surgical operations in the USA and Great Britain. Usage spread quickly but it is not easy to administer and unpleasant to inhale. About a year later chloroform was introduced; it seemed more 'patient friendly'. However, Chloroform has been able to shut down the heart of the strongest and healthiest man ... Chloroform remained in use!


In 1877, Johann Friedrich August von Esmarch (1823-1908) published the chloroform set presented here.
"Esmarch published his chloroform anesthetic apparatus in 1877. He introduced his invention as a so-called" chloroform cutlery. "This set consisted of the described mask, a dropper bottle with chloroform and a pair of tongue pliers.The set was housed in a leather case and primarily for the It was also widely used in civilian operating theaters for decades, and in principle, the chloroform set around 1900 was all the equipment of an anesthesiologist. "
www.aerztewoche.at/viewArticleDetails.do?articleId=3204

 

The masks lay loosely in drawers and glass showcases in everyday clinical practice. The family doctor and the military surgeon, however, picked up the mask neatly in a sturdy leather bag that they carried with them over land: a pear-shaped leather case in which the mask, a LOMSKY dropper bottle, and a straight, flat tongue pliers could fit.


In obstetrics, the use dominated by inhalation, in dentistry, the chloroform was used rather locally:
"Of all the most recent remedies, which have an analgesic effect and are used in particular in every form of toothache, chloroform is praised, and its mode of application by evaporation and inhalation is not mentioned here, especially since this type of use is not always without danger to health and Life is and can not be done without a watching doctor, only its local use on the painful place itself, by wetting a little cotton with one or a few drops and presses on the painful tooth and gums, also rubs it neatly with the cheek , be mentioned here ".


Chloroform was inhaled from a cup that the patient held in his hollow hand, or administered via a tissue or compress that was pressed onto the patient's nose. More elegant was the use of a mask: the patient counted from 200 backwards, breathing through his mouth, 7-15 grams of chloroform were generally enough to put an adult in anesthesia.

 


Nota: The chloroform set was originally intended for use on the battlefields (ESMARCH specialized in this particular type of surgery). The copy presented here belonged to a completely peaceful contemporaneity: it comes from the estate of Diekircher general practitioner Paul HETTO (1895-1979), who was established in 1925.

Anesthesia


Chloroform mask (3a)

abb85

Mask from SCHIMMELBUSCH, about 1900

 

 

Despite its liver toxicity, chloroform has long been a popular anesthetic. Sometimes, however, it had to go "without": "This morning the injured foot was amputated over the left knee over the knee." Because of his excessive state of weakness, the regretful could not be chloroformated, his condition is very questionable "(Luxemburger Wort, 16.5.1911).



The man died after a few hours: "Esch a.d. Alz., May 17. The worker killed in the Clair-Chêne Fußhöller died this morning" (Luxemburger Wort, 17.5.1911).



Presented is a simple construction from 1900 (by SCHIMMELBUSCH first mentioned in 1890), with bracket, frame and handle made of chrome (the frame could be sterilized and thus corresponded to the requirements of aseptic) were obtained with any cover of the required size.



Manufacturer: Aesculap AG, Tuttlingen, Germany. Dimensions: approx. 17.5 x 11 x 5.5 cm. The Schimmelbusch mask consists of an oval metal frame with handle, a revolving, hinged clamping handle with handle and a cross-shaped metal mesh that can be folded out half-round. The Aesculap logo is hallmarked on the front of the frame and the number 3 on the frame handle. The Schimmelbusch mask was considered a standard device for narcotization until the beginning of the 20th century. With the help of the wire frame, gauze compresses or tulle were stretched over the nose and mouth and drizzled with vapor inhalation anesthetics (usually with the help of a Y-dropper). For the first time, excess liquid could be drained and collected via the side channel of the Schimmelbusch mask: the Schimmelbusch mask, a further development of the ESMARCH mask, was the first to be equipped with a gutter to absorb the excess active substances.


Curt Schimmelbusch (1860-95), Surgeon, Berlin. He became world famous for his contributions to the development and scientific justification of mechanical sterilization methods developed in Berlin under Ernst von Bergmann. He was never seen as a pioneer of anesthesia. His surgical career began in 1888 in Cologne under the famous surgeon BARDENHEUER. In 1890, he describes his mask for ethereal and chloroform anesthesia under primarily aseptic aspects. "Curt Schimmelbusch was born on November 16th, 1860, as the son of a lord of a manor in Gross-Nogath / West Prussia." Having graduated from high school in 1882, he studied medicine at Wurzburg, Gottingen, Berlin and Halle He was trained as a co-worker at the University of Halle in 1886 as a co-worker of the histologist and pathologist at the Burgerhospital.And the main aspects of hygiene are described in a mask in 1890, which is predominantly used for ether anesthesia, although it is considered to be suitable thus for chloroform anesthesia, in itself an exciting contribution he has made characterizing the progress of anesthesia in German-speaking countries up to the mid-50's of the 20th century ".

 


Source:
Reinhard M, Eberhardt E., Curt Schimmelbusch, development of a mask for chloroform and ether anesthesia based on primary aseptic principles, in: Anasthesiol. Intensivmed. Notfallmed. Schmerzther. 1994 Feb;29(1):30-5.

Anesthesia


Chloroform mask (3b)

Masken Munchen 1
 

"SCHIMMELBUSCH- masks. Simple construction (around 1890) with bracket, frame and handle made of chromium suitable for an aseptic process, was covered with any desired size coating. For use with ether, an impermeable fabric was additionally pulled over the fine wire mesh.



Decisive are the foldable, collapsible facial tent and the gutter.



The Schimmelbusch masks were the first to be equipped with a gutter to absorb the excess active ingredients. The frame of the mask can be sterilized and thus meets the requirements of aseptic "(Anesthesia Museum, Bochum).


This mask was originally designed by Dr Curt Theodor Schimmelbusch (1860-1895) in 1890 to administer ether (or chloroform) to anesthesia patients undergoing surgery Schimmelbusch attempted to improve his original anesthetic mask design in 1895, but it was not a success; The mask is designed to fit the contours of a person's face 10 to 12 layers of Gamgee gauze (a surgical dressing invented by Joseph Sampson Gamgee of Birmingham, England, 1880, of a thick layer of absorbent cotton wool between two layers of absorbent gauze) applied over it and clamped in place during This frame keeps the patient away from the patient to make it more comfortable and acceptable for the patient Ronald Lo, The Schimmelbusch mask, in: Hong Kong Med J 2014, Dec; 20 (6): 560-1).


2 different Schimmelbusch masks, acquired at a flea market in the Olympiapark / Munich 9/2018