George Edward Fell (1849 – 1918)

George Edward Fell (1849 – 1918) was an American surgeon, engineer and inventor

Fell was the innovator of ‘forced respiration’ better known as IPPV, a method he developed in anaesthetised dogs and later adapted for human use. He found its applications in patients with opiate overdoses and advocated for its broader use in other life-threatening conditions including traumatic shock, asphyxia and thoracic surgery.

Unfortunately, Fell was met with great resistance from the medical community and the Fell method of respiration never reached widespread uptake into practice. Instead, he spent much of his career tenaciously campaigning for its use and seeking recognition for his efforts.

The Fell apparatus however, did eventually rise to prominence to outlive its inventor by the efforts of John O’Dwyer (1841-1898) and Rudolph Matas (1860-1957) who introduced modifications giving the apparatus a more established presence in the medical world.

On an interesting side note, Fell was involved in the final design of the electric chair, an endeavour that he felt enabled a more “humane execution,” a humorous paradox to the medical professional he was.


Biography
  • Born on July 10, 1849 in in Chippewa, Ontario
  • 1869 – completes engineering studies, University of Buffalo and begins working as a Buffalo city engineer
  • 1879 – founding member of the American Society of Microscopists; works as assistant engineer on Ontario-New York State International Bridge whilst concurrently studying medicine
  • Paradoxically, works on the design and creates the first electric chair; he conducts a series of studies in dogs on the effects and methods of electrocution. Despite being against Capital punishment, views his work as means to create a more ‘humane’ method of execution
  • 1882 – MD, University of Buffalo defends thesis on the ‘Histology of aneurismal clots
  • 1884 – Chair of Physiology and Microscopy at Niagara University; studies and develops methods for applying IPPV with household bellows through a tracheotomy in anaesthetised dogs. Remarks that “if the respirations could be kept up by suitable means for a sufficient time to permit the elimination of the poison, life may be saved…
  • 1886 – Witnesses the attempted resuscitation of a man with morphine overdose, resolves to better the methods for artificial respiration

Electricity, atropia, coffee extract, brandy and active movements were used. Artificial respiration, by “Sylvester’s” method, was also employed…but the patient soon succumbed to the inevitable. At this time, I felt keenly the inadequacy of the methods at our command, and then resolved, if opportunity ever offered, to make the operation which I have now to record and which, I believe, might have saved Mr. Dyke’s life.

Fell 1887

Medical Eponyms
Fell’s apparatus

Fell’s initial apparatus was developed from his experiments in anaesthetised dogs and comprised a foot bellow connected via rubber tubing to a ‘one piece’ unit which included a directional control valve and a tracheotomy tube. The stop cock on the valve had to be manually turned by hand for each inspiration and expiration.

Fell’s apparatus 1910
Fell’s apparatus for “forced respiration”, comprising: 1. double bellows or air supply device; 2. air valves with oxygen and anaesthetic tubes; 3. air cup or face mask, intubation tube etc; 4. oxygen supply apparatus; 5. anaesthetic container; 6. anaesthetic control valve; 7. rubber manometer; 8. three-way connections; and 9. Maelzel metronome. Fell, 1910

Following his landmark case in 1888, Fell modified the design of his apparatus to adapt it better to human use. The bellows were equipped with a rubber equaliser to enable smoother and more rhythmical delivery of air; the control valve was swapped for a two-way valve which could be controlled by the operators’ fingertip to deliver IPPV as needed. The tubing was changed to a more flexible one and inserted between the valve and tracheotomy tube. This prevented tugging on the trachea from the turning of the stop cock, a problem with the original design.

He who would attempt to save human life by forced respiration must be supplied beforehand with suitable apparatus

Fell, 1889

The apparatus could also be used to deliver IPPV with a face mask rather than tracheotomy and whilst Fell did successfully manage some patients with this method, he was faced with the complication of gastric insufflation and aspiration.

For physicians who were reluctant to perform a tracheotomy, the option for face mask and IPPV made Fell’s method more attractive as well as encouraged its use. It could also ‘buy time’ for the moribund patient to relieve the acute crisis so that a tracheotomy could then be performed safely. However, control for the rate of respiration was quite strenuous on the operator (or so it appears) with Fell noting that “…bellows working at the rate of 108 movements per minute, patient by this means receiving 21 respirations to the minute” [Case V, 1888].

Perhaps most prominent of the modifications to this apparatus, were the additions made by Joseph O’Dwyer (1841 – 1898) who replaced Fell’s tracheotomy with his own laryngeal tubes thus introducing the ‘Fell-O’Dwyer apparatus.’ Fell initially objected to intubation stating that it ‘would prevent the imbibing of fluids, through which means we may most readily aid elimination of the poison’ and that ‘the time lost in attempted intubation in drowning cases would make the operation impractical.’

Fell’s viewpoint later changed as the Fell-O’Dwyer apparatus became more established in clinical use and designed his own laryngeal tube in 1908 – a tube he felt was less injurious than that of O’Dwyer’s (although never quite gained the traction as did O’Dwyer’s tube in medical practice).

The Fell-O’Dwyer apparatus underwent several modifications over time.

The apparatus was introduced to Charity Hospital in New Orleans by surgeon Dr J.D. Bloom who adapted the apparatus (Fig c.) for use for pulmonary insufflation in asphyxia neonatorum. His modification is described in a paper on ‘Intralaryngeal Insufflation’ by vascular surgeon Rudolph Matas (1860-1957) in 1900:

Dr Bloom has found it advantageous to modify the accessory or inflating part of the apparatus by several additions which deserve mention, as they save unnecessary exertion on the part of the operator and diminish the strain on the bellows…“a long lever (…) used as a treadle to compress the bellows with the foot…a metallic cylinder which is fitted with absorbent cotton to filter the air as it passes from the bellows to the patient

Matas 1900
Fell-O’Dwyer apparatus and modifications 1895 1900
a. Original Fell-O’Dwyer apparatus (1895);
b. Fell apparatus for artificial respiration (1900);
c. J. D. Bloom’s modification of the Fell-O’Dwyer apparatus (1900);
d. Matas modification of O’Dwyer’s intubating apparatus (1900);

A tube could also be attached to an oxygen source to provide oxygenation during cases of asphyxia.

Dr Matas’ modification of the Fell-O’Dwyer apparatus (adapted for his use for intrathoracic surgery, see Fig d.) included the addition of a cone with a stop cock that controlled the supply of anaesthetic gases without “interfering with the passage of air furnished by the bellows or air pump.” A pistol shaped handle was also designed to allow for easier control.

I have also modified the apparatus so that it is provided with one aspirating as well as insufflating valve. While the aspirating valve is rarely used, it may occasionally find application in cases of excessive clogging of the larynx with mucus, food, foreign matter and other substances that may threaten life by their presence…the aspirating valve may be utilized to insufflate oxygen pure or mixed with atmospheric air

Matas 1900

Criticisms

Fell was a strong advocate of his method for forced respiration giving often opinionated remarks against other medical colleagues who he felt were not giving him due credit for his work. These included Dr Jean Baptiste Vincent Laborde and Professor Horatio Wood who had separately recommended forced respiration without acknowledging ‘Fell’s Method.’

To be denied the credit which should in all fairness be accorded to the practical originator of a method of such far-reaching importance in the saving of human life is what I could not and will not quietly submit to. “Honor, gentlemen, to whom honor is due.

Fell, 1893: 124

Fell held particular resentment against Marshall Hall (1790-1857) whom he felt bore in part the responsibility for the medical professions’ resistance to forced respiration where “…the prevailing opinion at that time was that the air vesicles of the lungs would not resist forcible mechanical measures in artificial respiration” [Fell, 1896]

Marshall Hall indeed, considered the use of bellows as highly dangerous

But another objection applies to the mode of inducing artificial respiration having the character of the forcing-pump.…a degree of force must be used, sufficient to raise the bony and other structures of the thorax….which both anticipation and experience prove to be injurious to the delicate structure of the lungs…found these structures variously lacerated by this measure in experiments with animals

The obvious conclusion is, that, whenever we attempt artificial respiration, the procedure must be effected with gentleness and slowness

Hall M: Asphyxia, presented to the Royal Humane Society in London 1856

Fell knew that his method would be considered sinful especially to those who upheld Marshalls strictures on artificial respiration however, Fell was far from timid in his beliefs:

And thus another human life was saved, and accident, prejudice or ignorance again frustrated by a method which that great medical authority, Marshall Hall, said should never be used and the whole medical world had accepted as “Law and Gospel,” which it is a medical sin to trespass upon.

So I am a medical sinner and a bad one, for I glory in my sin, which has now saved a few hundreds of human lives and is destined to save thousands.

Fell GE, 1899

The electric chair

Electrocution, which was first suggested by Dr. AP Southwick of Buffalo, N. Y., was made practical by the investigative work of Dr. Fell. He made the vivisection experiments which resulted in his conclusion:

First – That death produced by a sufficiently powerful electrical current is the most rapid and humane produced by any agent at our command. Second – That resuscitation, after the passage of such a current through the body and functional centres of the brain, is impossible. Third – That the apparatus to be used should be arranged to permit the current to pass through the centres of function and intelligence in the brain

Fell, Obituary 1918

Major Publications

References

Biography

Eponymous terms


eponymictionary CTA

eponym

the person behind the name

Emergency registrar at Sir Charles Gairdner Hospital, Perth

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.