Improved Method and Means for Administering Respirable Anaesthetics.
Year: 1898

page_text: Date of Application, 10th Aug., 1898
Complete Specification Left, 10th May, 1899-Accepted, 9th Sept., 1899
Improved Method and Means for Administering Respirable
Anaesthetics.
ROBERT MARSTON, Palissy House, Narborough Road, Leicester, in the County
of Leicester, Dental Surgeon, do hereby declare the nature of this invention to
be as follows:-
-
My invention comprises one, or more, single, or double, oral-buccal-terminals,
having suitable openings for delivering respirable narcotics inside the mouth
of patients. These oral-buccal-terminals are so named, because, when in use,
they are situated near one or both cheeks inside the mouth. Each oral-buccal-
terminal is attached to, or forms part of, a lip distender constructed in such a
manner as to enable it to clutch or clasp both sides of the patient's cheek. These
lip-distenders or cheek compressors may approximately fit and protect the
junction of the upper and lower lips, and are further secured in position by one
or more springs, adjustable between the gingival, and buccal, surfaces of the
mouth; or by external wires, springs, cords, bands, links, gauze, netting, or
other suitable appendages, so arranged as to encircle the chin, ears, and as much
of the head, neck, and face, as is deemed to be sufficient or desirable. The
herein before mentioned oral-buccal-terminals, are the delivery nozzles of one
or more tubes, which for convenience, at a proper distance from the terminals,
are enveloped in one or more trunk-tubes, which convey the anaesthetic and its
gaseous antidote, conjointly, alternately, or separately, from suitable storage-
receptacles to either or both sides of the patients mouth. These trunk-tubes
namely the regulating and the anterior trunk tubes are provided with a distend-
able, and contractable, reservoir, for equalising pressure, and maintaining con-
tinuity of flow. The appliance also includes a nasal compress, for preventing nose
breathing, when temporary cessation of that function is necessary. The appliance
including nasal compress may be partly, or wholly, composed, of bone, ivory,
leather, skin, textile fabrics, wood, metal, porcelaneous substances, compounds
of caoutchouc compounds of gutta percha, and other gums or resinous substances,
compounds of linolein, compounds of olein, from any available source, compounds
of glue, or gelatin, compounds of pyroxylin, celluloid, xyloidin, or any other
similar, or equivalent material.
When chloroform or any other narcotic possessing similar fluidity and vola-
tility under the normal conditions of the common atmosphere, is administered by
means of this invention, the narcotic must be previously diffused, and indeed,
absorbed, by a proper volume of air contained in a gasometer, or other storage-
receptacle, the ratio of components, and its consequent physiological intensity,
being modified according to individual requirements.
Nitrous oxide is usually delivered without previous dilution, because, by
regulating the pressure or flow of the anaesthetic, sufficient of the surrounding
atmosphere may be allowed to mix with the "gas as it passes along the mouth
towards the glottis to furnish the proportion of oxygen required by any pre-
"

page_text: determined formula, whenever it is the intention of the operator to gorge the
saturation capacity of the red corpuscles of the blood with such a formula in
preference to a respiratory cargo of pure nitrous oxide. Nevertheless, nitrous
oxide is sometimes previously mixed with manufactured oxygen, or its equivalent
common air. Sometimes, however, nitrous oxide is impregnated with varying
proportions of narcotic vapour, such as chloroform, ether, and other compounds
capable of exercising similar direct action upon the patient.
The different methods eniployed by their respective advocates for producing
anaesthesia, indicate how much, practitioners are at variance in their views
regarding the physiological action of anaesthetics generally, and nitrous-oxide in
particular. Doubtless imperfect inhalers "have played no inconsiderable part
in the formation of these theoretical and operative differences. The common
dangers attending the ordinary methods of administering chloroform, ether, and
similar narcotics, have, frequently, been the subject of discussion, by experts
desirous of discovering some means, that would enable them to minimize the too
frequent and fearful consequence of what they recognize is a rule-of-thumb-
practice. But no instrument embodying their requirements has ever before been
placed in their hands. I believe that this invention, simple as it is, will enable
operators to formulate their respiratory atmosphere so that the known ratio of
its components, passing into the lungs, shall be unvarying, at every inspiration.
It will enable operators to gauge with precision the progressive phases of the
anaesthetising process, and by bringing these vital points within the range of
intellectual control will protect patients by removing what is extensively
believed to be the chief cause of dangerous reflex action, an occurrence that
has destroyed an appalling number of lives, and is dreaded by operators, at every
anaesthetic operation.
Dated this Ninth day of Avon 1808
Improved Method and Means for Administering Respirable
Anæsthetics.
ROBERT MARSTON, Palissy House, Narborough Road, Leicester, in the County
of Leicester, Dental Surgeon. I do hereby declare the nature of this invention
and in what manner the same is to be performed, to be particularly described and
ascertained in and by the following statement:
This invention comprises suitable means for formulating aeriform mixtures
containing chloroform, ether, the compound known by the name ACE and other
narcotics in proportion of any desired strength with perfect accuracy, the
narcotic is perfectly diffused, its percentage is precisely indicated and auto-
matically controlled therefore these atmospheres are presented to the lungs
in the ratio of proportions indicated by each formula. The same means formu-
late mixtures of nitrous oxide and air. Nitrous oxide plus oxygen. Nitrous
oxide plus narcotics and are capable of delivering nitrous oxide, in such a
manner as to prolong (without deepening) anæsthesia according to the varied
requirements of patients.
Thus human life is safe-guarded and anæsthetists are now enabled to prescribe
respirable narcotics and other anaesthetics with perfect accuracy, and certainty,
for anesthetists know by these means what percentage of narcotic their patients
are breathing at each inspiration; the physiological action of each dose, and

page_text: exactly how much of the poison has been internally administered during the
whole period of the operation.
The apparatus is made up of many parts the names of which I will first
enumerate and then I will more particularly describe them, and afterward shew
their action as exemplified in the adaptability of their combination which con-
struction I will hereinafter distinguish by the term anæsthetiser.
My anaesthetiser comprises oral buccal terminals, A', branch-tubes Z anterior
trunk tube Q regulating trunk tube R, hereinafter called apportionator. Dis-
tensible and contractible reservoir Y, hereinafter called the reservoir and storage-
receptacle, A.
Having enumerated the names of the principal parts of my anæsthetiser, I
will proceed to describe more particularly their construction and use. I shall
be able to do this more easily and more clearly by reversing the above enumera-
tion that is to say: shewing the construction of my anæsthetiser by commencing
with a description of the storage-receptacle A, and finishing with a description
of the oral-buccal-terminals Z thus:-
The storage-receptacle A, is a metallic vessel of any convenient shape, but
preferably cylindrical in form. It is furnished with a suitable opening N, for
the introduction of liquids; this opening is provided with a screw stopper. The
storage receptacle A, is also furnished with a pressure guage, O, whose function
it is to indicate the volume of respirable atmosphere forced in by its central
pump D, E, or by other means hereinafter described. The storage-receptacle is
strong enough to withstand a very much greater bursting strain than that
indicated by its pressure guage. As herein before explained the storage receptacle
in which the stock of respirable mixture is made, is provided, with a pump D, E,
which occupies a central position within the cylinder A. The handle E & pump
collar M, being exposed are accessible for working the piston D), or removing
it whenever the wear of the piston necessitates its removal and renewal. This
pump D, E, is provided with an ordinary check valve H, and also an ordinary
sealing valve F, G, suitable for preventing an outrush of gas during during the
operation of pumping in the charge, and for sealing up the charge for an indefinite
period when not required for immediate use. The storage-receptacle A, is also
provided with several taps P P P P, which may be used both as inlets and outlets
as occasion may require.
At the bottom of the storage-receptacle is a syphon tap K, capable of with-
drawing the fluid residuum of the storage-receptacle A, under pressure or other-
wise as circumstances may necessitate, and be it. known, it is by no means
necessary that the pump should occupy the central position, herein before men-
tioned, for it is self evident that the storage receptacle might be supplied with
air by an external pump but that would be equivalent in its action, and incon-
venient, and for other reasons undesirable. The storage-receptacle A is also
provided with a main outlet Q leading through the tap P to the regulating-
trunk-tube, or apportionator R. This apportionator R, is either stationary or
attachable and is supplied through a stop-cock P, with compressed atmosphere
from the storage-receptacle A, and operates in the manner hereinafter described.
This apportionator R, consists of a comparatively large tube, preferably, having
a larger diameter at one end, the larger end is plugged or closed with a fixed
perforated disc T through whose centre there passes a smaller tube the free end
of which has been partially closed or otherwise made to form a very contracted
nozzle S, which communicates with and is continuous with the bore or inside
capacity of the larger tube R. External to the fixed perforated disc T, in
close contact with its outer surface and capable of being rotated round the
central tube, a similarly perforated revolving disc U is adjusted whose similar
alternated openings and divisional sections of metal are continuous with those
formed in the fixed perforated disc whenever the rotating disc is placed in a
certain position: the perforations or spaces being then open, but any movement
of the revolving disc from that position produces a corresponding closure of

page_text: the spaces until they become quite closed which happens when the divisional
sections of the revolving disc are brought by rotation just opposite the cut
out spaces or perforations of the fixed disc which are thus obscured. The range
of motion thus described by the revolving disc U is accurately divided into
degrees which are properly numbered V. These numbers are distinctly indicated
by a suitable pointer U carried by the revolving disc U, if the degrees be
marked upon the large tube R but if the graduations are marked upon any part or
connection of the revolving disc U the pointer U¹ is then carried by the tube R.
Although I prefer a revolving disc for regulating the flow of external atmosphere
into the bore of the large tube I sometimes use instead a revolving or sliding
outer-tube moving upon a smaller inner-tube one or both of which in either
case are suitably perforated with openings that open or close according to the
motion of the outer tube which is indicated in the manner already described all
these devices are equivalent to each other their action being identical as it
depends upon the central nozzle forcibly injecting a stream of atmosphere from
the storage receptacle A into the bore of the large tube R, thereby creating a
partial vacuum by displacement of air which has been impelled forward and
ejected by the impetus of the injected stream, the external air then rushing into
the large tube through the perforations when the relative position of the revolving
dise (or its equivalents namely the revolving or sliding tube or other con-
trivance whose action is the same,) is suitably adjusted.
Having now described the apportionator I will proceed to describe its adjacent
fitting namely the T shaped bifurcated, trifurcated or other shaped anterior-
trunk-tube W which connects the distensible reservoir Y with the appor-
tionator R, and also with the branch tubes Z which convey anæsthetics to the oral
buccal terminals A¹. If a T shaped anterior trunk tube is used one end is
attached to and made continuous with the delivery end, that is to say the free
end of the apportionator R another end is attached to and feeds the distensible
reservoir Y, and the other end merges into a flexible extension X sufficiently
long and flexible to afford the range of motion required during anæsthetisation.
Instead of using a T shaped anterior trunk tube prefer to use a four ended
trunk tube one end of which when adjusted is continuous with the free end of
the apportionator two ends namely an inlet and outlet are attached to the
distensible reservoir Y the other end merging into the flexible extension X
which as hereinbefore explained must be sufficiently long and flexible to afford
the necessary_motion. This contrivance conducts the atmosphere from the
apportionator R to the distensible reservoir Y and thence through the flexible
extension X to the branch-tubes Z two of which are joined to each oral buccal
terminal A¹. The terminals single and double are of several shapes to suit the
peculiar requirements of different operations. They deliver anaesthetics inside
the mouth. These oral-buccal terminals are so named because when in use
they are situated near one or both cheeks inside the mouth. Each oral buccal
terminal is attached to and forms part of a lip distender constructed in such a
manner as to enable it to clutch or clasp both sides of the patients cheek. These
lip-distenders or cheek compressors may approximately fit and protect the
junction of the upper and lower lips and are further secured in position by one
or more springs, cords, bands, links, guaze netting or other suitable appendages
so arranged as to encircle the chin, ears and as much of the neck & face as is
deemed to be sufficient or desirable. These oral-buccal-terminals are also attached
to one or more branch tubes whose supply they deliver inside the mouth.
nasal compress for preventing nose breathing is used whenever temporary cessa-
tion of that function is necessary.
A
The several parts of this anesthetiser hereinbefore described may be partly
or wholly composed of bone, ivory, leather, textile fabrics, wood metal,
porcellaneous substances; compounds of caoutchouc compounds of gutta percha
and other gums and resinous substances compounds of linolein, compounds of

page_text: olein from any available source compounds of glue, gelatin pyroxylin, celluloid
xyloidin or any other equivalent material.
Having now described the construction of my anæsthetiser I will give one or
two examples of its use:-If chloroform is being used, sufficient of it to saturate
the residual atmosphere of the anaesthetiser is introduced into the storage
receptacle, any excess may be withdrawn through the syphon tap. The pro-
portion of chloroform required to saturate any given volume of common air
depends upon the temperature of the atmosphere, for example at 50° Fahr.
92 cubic inches of air take up about S minims of chloroform, at 55° Fahr.
90 cubic inches of air absorb about 10 minims of chloroform, at 60° Fahr. 88
cubic inches of air take up about 12 minims and at 65° Fahr. 85 cubic inches
of air absorb about 15 minims of chloroform forming therewith a mixture
composed of 85 cubic inches of air and 15 cubic inches of chloroform vapour.
Supposing the residual atmosphere of the storage-receptacle contained 15 per
cent. of chloroform vapour the percentage would be lowered by pumping air
into the anesthetiser thus: when the guage indicated 15 lbs. pressure on the
square inch the percentage of chloroform vapour would be 7 at 30 lbs. there
would be 5 per cent. of chloroform vapour; at 45 lbs. 33 per cent., at 60 lbs. ;
3 per cent, and at 75 lbs., 22 per cent. a proportion which is quite capable of
causing anesthesia.
Another way of mixing is as follows:-When an atmosphere containing, say,
12 per cent. of chloroform vapour is passed from the storage receptacle through
the apportionator and the pointer is placed at Figure 1 the proportion of chloro-
form vapour remains at 12 per cent. but if the pointer be placed at Number 2
the atmosphere issuing from the apportionator will contain 6 per cent., when the
pointer is placed at number 3 the mixture contains 4 per cent., if the pointer
be placed at number 4 the mixture will contain 3 per cent., when the pointer
indicates number 5 the mixture contains 25 per cent., when number 6 is indi-
cated the mixture contains 2 per cent. when number 7 is indicated the proportion
of chloroform vapour is 17 per cent. at number 8 the percentage is 1½ at
number 9 the percentage is 13 and at number 10 the percentage is 1.
Whatever proportion of chloroform vapour the storage receptacle contains the
apportionator when set at the percentage required automatically works out the
proportions required, and passes on the atmospheric mixture to the distensible
reservoir.
When the compound called ACE is preferred. It must never be used in
quantities quite sufficient to saturate the atmosphere at any temperature for fear
of separating either alcohol or chloroform or both. This rule must be observed
when using any mixture of narcotics whose density and volatility are dissimilar.
Every medical practitioner understands that the compound called ACE is
composed of alcohol 1 part chloroform 2 parts and ether 3 parts.
Mixtures of nitrous oxide and oxygen gas are made by passing the required
volume of nitrous oxide from a gas bottle into the anaesthetiser and subsequently
introducing in the same way but through another tap the volume of oxygen
required to complete the formula. The proportions being adjusted by reference
to the pressure guage.
When nitrous oxide plus norcotics is used the mixture may be formed by
pouring a measured quantity of the narcotic into the storage receptacle and then
charging the anesthetiser with compressed nitrous oxide from a gas bottle until
the pressure guage, indicates the volume required to complete the formula.
These examples are only given to illustrate the action of the anesthetiser, they
do not by any means shew its full range of adaptability.
When low percentage atmospheres are formulated in the storage receptacle
the terminals may receive the medicated atmosphere through one of the. taps
herein before mentioned direct from the storage receptacle.
Nitrous oxide may be administered to patients in a similar manner. An

page_text: ordinary Face-piece" may be adjusted to the flexible extension of the trunk
tube whenever the nature of an operation requires its adoption.
In the accompanying sheets of drawings the following letters explain the
construction and relation of the parts composing my anæsthetiser.
A is the storage receptacle.
Bis the containing tube.
B is the handle, one on each side for lifting and carrying the apparatus
whenever it is necessary to move it, from place to place.
C is the pump-barrel.
D is the pump-piston.
E is the pump handle.
F is the valve seating.
G is a bush."
"
H is a check-valve provided with side-holes.
I, is the valve-leather.
J, is the pump-support, or "stretcher."
K, is the syphon-tap.
L, is the stand with legs.
M, is the milled collar.
N, is the inlet closed with a screw or other suitable stopper.
O, is the pressure-gauge.
P P P P are taps.
Q, is the main outlet.
R, is the regulating trunk-tube called the apportionator.
S, is the nozzle.
T, is the fixed perforated back plate.
U, is the revolving-perforated back plate.
Vis the quadrant suitably divided and figured.
W, is the tee shaped anterior trunk tube one end of which communicates
with the apportionator R another end communicates with the distensible reser-
voir and its other end merges into the flexible extension X.
X is the flexible extension of the trunk tube.
Y is the extensible bag.
Z, Z, Z, Z, are branch tubes which lead up to and supply the oral buccal-
terminals.
A¹ A¹ are oral buccal terminals.
Having now particularly described and ascertained the nature of my said
invention, and in what manner the same is to be performed, I declare that what
I claim is
1. A metallic or other storage receptacle, having a central pump or other
inflator and also a pressure gauge or pressure regulator for the purpose herein-
before explained and provided with a main outlet hereinbefore called the appor-
tionator or regulating trunk tube for apportionating and diffusing vapours,
gases, and air in the making of aeriform anaesthetic mixtures, which it injects
into a suitable reservoir.
2. Oral buccal terminals namely one or two bent tubes having one or more
facial inlets and one or more oral outlets, and whose function it is to deliver
anæsthetic mixtures, inside the mouth for causing and prolonging anesthesia.
Dated this 4th day of September 1899.