The intubating laryngoscope and development of the modern blade
| Year | Person / instrument | Historical contribution and significance |
|---|---|---|
| 1903 | Chevalier Jackson (1865–1958) | Developed a U-shaped tubular laryngoscope with a spatula and handle. Subsequent modifications introduced distal illumination and improved access for tracheal intubation. |
| 1910–1912 | Gustav Killian (1860–1921) and contemporaries | Development of suspension laryngoscopy to allow bimanual surgical procedures with the larynx exposed. The separate contributions of Killian, Brünings to review |
| 1913 | Chevalier Jackson | Published techniques for direct-vision tracheal intubation. His instruments incorporated distal lighting and, in some versions, a removable sliding floor. Also the Boyce–Jackson position |
| 1913 | Henry Harrington Janeway (1873–1921) | Described a purpose-designed anaesthetic laryngoscope with a distal light, batteries housed within the handle and a blade configuration facilitating tracheal catheter placement. |
| 1919–1920s | Edgar Stanley Rowbotham (1890–1979) and Ivan Whiteside Magill (1888-1986) | Developed methods of endotracheal anaesthesia for reconstructive facial surgery. Their contributions included intubation techniques, tubes, instruments and related airway equipment. |
| 1926 | Ivan Whiteside Magill | Published An improved laryngoscope for anaesthetists. Described a straight, open-sided laryngoscope designed to facilitate passage of tracheal catheters and tubes. |
| 1928 | Paluel Flagg (1886-1970) | Published a description of a laryngoscope for exposure and illumination of the pharynx and larynx. The Flagg blade became one of the important pre-Miller straight-blade designs. |
| 1930s | Arthur Ernest Guedel (1883–1956) | Developed the Guedel laryngoscope blade, with a large U-shaped flange and an altered blade-to-handle angle, intended to facilitate intubation. Its precise introduction date remains to be established. |
| 1936–1939 | Gillespie / Shadwell laryngoscope | A modified Jackson-type laryngoscope developed for paediatric intubation. Designed in 1936 and described in 1939. |
| c.1939 | Wisconsin blade | A straight blade associated with Wisconsin General Hospital, Madison. The Foregger Company manufactured a related design, commonly called the Wis-Foregger, around 1939. |
| 1941 | Robert Arden Miller (1906–1976) | Published A new laryngoscope in Anesthesiology. Introduced a longer, narrower, relatively straight blade with a gently curved distal tip, designed to improve epiglottic elevation and reduce dental trauma. [Miller laryngoscope] |
| 1943 | Robert Reynolds Macintosh (1897–1989) | Published A new laryngoscope in The Lancet. Established the familiar curved blade and advocated routine positioning of the blade tip in the vallecula to achieve indirect elevation of the epiglottis. [Macintosh laryngoscope] |
| 1944 | Macintosh blade patent | The Foregger Company’s United States patent was granted in July 1944. The history of Richard Salt, early manufacture and alternative English/American blade designs belongs in the existing Macintosh EPY. |
| 1946 | Miller infant blade | Miller described a modified blade specifically for infant intubation, recognising the limitations of his original adult design. [Miller blade] |
| 1947 | Robert Louis Soper (1908-1973) | Published A new laryngoscope for anaesthetists. Modified the straight-blade design to help control a long or floppy epiglottis. |
| 1952 | Robert Bryce-Smith | Laryngoscope blade for infants, later associated with the Oxford/Bryce-Smith blade. |
| 1954 | R. B. Gould | Modifications of Soper blade, including changes to the flange and distal blade configuration. |
| 1958 | Bizzarri–Giuffrida blade | Modified Macintosh-style blade with the vertical flange removed, reducing the blade’s profile and improving space within the oral cavity. |
| 1962 | Snow blade | Developed a straight blade with a curved distal tip and altered flange to improve epiglottic control and passage of the endotracheal tube. |
| 1973 | Phillips blade. Schapira blades | Two straight-blade modifications addressing blade geometry, the vertical step, visualisation and tube delivery. find original articles |
| 1977 | Kessell blade | Described a blade with a 110° blade-to-handle angle for obstetric intubation, reducing interference from the patient’s chest or breasts. |
Further reading
- Jones T, Gililand L. Early laryngoscopy. Illumination, mirrors and the first direct view (1743–1896)
- Gililand L, Jones T. The intubating laryngoscope and development of the modern blade (1903–1977).
- Gililand L, Jones T. Fibreoptics, difficult-airway blades and videolaryngoscopy (1967– )
References
eponymictionary
the names behind the name
MB ChB, Edinburgh Medical school. F1/F2 in Bath, now in Australia, Perth preparing for a career in Emergency medicine. I have an interest in wilderness medicine and women’s health, but haven’t fully found my niche interest yet.
MBChB - Liverpool. RMO in Emergency Medicine at Sir Charles Gairdner Hospital, currently soaking up the sun down under. Aiming to pursue a career in anaesthetics.