Ivan Magill

Biography

• Born on July 23, 1888 in Larne, County Antrim, Ireland.
• 1913 – Graduated MB BCh BAO from Queen’s University Belfast. As a medical student he had administered approximately 60 anaesthetics, but received no formal specialist training in anaesthesia.
• 1914–1918 – Commissioned into the Royal Army Medical Corps during the First World War. Served with the Irish Guards at the Battle of Loos and later at a field hospital in Rouen.
• 1919 – Posted to the Queen’s Hospital for Facial and Jaw Injuries at Sidcup, where Harold Gillies had established his pioneering reconstructive surgery unit. Magill met fellow RAMC officer Stanley Rowbotham. Neither had specialist anaesthetic training, but together they began developing airway and anaesthetic techniques suited to complex facial surgery.
• 1920 – Queen’s University Belfast rejected Magill’s MD thesis on anaesthesia for plastic surgery as being of insufficient practical value. The university later awarded him an honorary DSc in 1945.
• 1923 – Appointed anaesthetist at the Brompton Hospital, with work extended to thoracic anaesthesia.
• 1924 – Appointed to Westminster Hospital, becoming its first full-time anaesthetist.
• 1931 – As Senior Secretary of the Section of Anaesthetics of the Royal Society of Medicine, proposed the creation of a formal Diploma in Anaesthetics.
• 1932 – The inability of the Royal Society of Medicine to institute such a qualification contributed to the movement that led to establishment of the Association of Anaesthetists of Great Britain and Ireland.
• 1935 – The first Diploma in Anaesthetics examination was held by the Conjoint Board. Magill was awarded the DA.
• 1938 – Awarded the Henry Hill Hickman Medal by the Royal Society of Medicine.
• 1939–1945 – During the Second World War served as Anaesthetic Adviser to the Emergency Medical Service and Civilian Consultant in anaesthesia to the Royal Navy.
• 1945 – Awarded an honorary DSc by Queen’s University Belfast.
• 1946 – Appointed Commander of the Royal Victorian Order (CVO) for his services to the Royal Family.
• 1948 – The Faculty of Anaesthetists of the Royal College of Surgeons was established. Magill was elected FFARCS, reportedly the second Fellow elected after the first Dean, A. Marston.
• 1951 – Elected FRCS.
• 1958 – Awarded the John Snow Silver Medal of the Association of Anaesthetists and later received Honorary Fellowship of the Faculty of Anaesthetists.
• 1960 – Advanced to Knight Commander of the Royal Victorian Order (KCVO).
• 1972 – Gave his final anaesthetic, aged 84.
• Died on November 25, 1986, aged 98

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Medical Eponyms

Magill forceps (1920)

Magill forceps are angled intubating forceps designed to grasp and guide a nasally introduced catheter or endotracheal tube through the glottis under direct vision without obscuring the operator’s view.

Magill developed the instrument at Sidcup as an alternative to Stanley Rowbotham’s guiding rod. The angled shaft cleared the line of sight, while the rounded, serrated jaws securely grasped the catheter without damaging its distal end.

1920 – Magill published Forceps for intracheal anaesthesia, acknowledging Rowbotham’s nasal intratracheal technique and describing the advantages of the forceps over the guiding rod.

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Magill curve (1928)

The Magill curve is the characteristic curvature of a preformed endotracheal tube, derived from Magill’s use of naturally curved rubber tubing for tracheal intubation.

1928 – In his description of blind nasal intubation, Magill observed that the airway from the nostril to the glottis formed a gentle curve and that a rubber tube with a similar curvature would naturally follow this path and enter the glottis.

The term Magill curve was subsequently applied to this tube geometry. Modern measurements place the standard radius of curvature at approximately 140 ± 20 mm, a configuration shown experimentally to be close to optimal for the average airway.

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Magill laryngoscope (1926)

Magill laryngoscope blade pre-dates the 1941 Miller straight-blade. The Magill blade was a straight-blade, with a U-shaped step and flange concave to the right. The step and flange continued to within an inch of the end of the blade.

The laryngoscope here illustrated, although conforming in general outline to other similar patterns, embodies certain features which have proved useful in passing catheters and their accompanying expiratory tubes through the larynx. These are: (1) efficient illumination from a lens-fronted electric bulb of the size usual in sigmoidoscopes; (2) the distal end of the speculum is flat, wide, and tilted slightly upwards-an advantage in elevating and controlling the epiglottis; (3) the unusual width of the slot at the side facilitates the passing of catheters and tubes for expiration without obscuring the visual field; (4) the lug at the proximal end of the handle affords a purchase for the thumb, which is of value in manipulating the instrument into position. The handle is not detachable, and the barrel, which is polished within as well as without, is constructed of stainless steel.

Magill 1926

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Magill anaesthetic apparatus (1927)

The illustration represents the fusion into one composite unit of an endotracheal ether insufflation apparatus and a nitrous-oxide and oxygen apparatus, both of which have been already described in the Lancet 1921 and Lancet 1923. The essential features of each have been retained with slight modifications as follows: (1) The unit is mounted upon a metal base, 9 inches by 6 inches, and can be carried in a bag without being dismantled. (2) The mechanical safety-valve and manometer are now fitted directly on the heating chamber. (3) The ether drop-feed has been altered to the shape of a dome which can be easily seen from any angle. (4) A water- sight-feed has been included for the administration of carbon dioxide.

Magill 1927

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Development and standardisation of Magill endotracheal tube (1920–1939)

Magill played a major role in the development and standardisation of endotracheal tubes, initially alongside Stanley Rowbotham at Sidcup.

Early techniques relied on narrow intratracheal insufflation catheters, with expiration occurring around the catheter or through a second return airway. Magill then moved to a single wide-bore tracheal tube through which the patient could breathe in and out, simplifying the system and allowing the anaesthetic apparatus to remain clear of the operative field.

Magill continued to develop specialised tracheal and endobronchial tubes for thoracic surgery, including cuffed tubes and instruments for one-lung anaesthesia. Reflecting on this work in 1976, he stated:

It was not invented by me, it was developed by me.

Magill, 1976

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Magill attachment

Thomas records Magill explaining in 1967 that he had devised the “Magill attachment” in the 1920s for use with a wide-bore tube, but had never published an original description. By 1967 it was still occasionally being used, although Magill himself had abandoned it as equipment evolved

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The Sir Ivan Magill Gold Medal (1988)

In 1988, to commemorate the centenary of his birth, the Association of Anaesthetists introduced the Sir Ivan Magill Gold Medal award for uniquely outstanding innovation in anaesthesia.

Winners of the award have shown extraordinary originality in developing the specialty of anaesthesia, through research, publications, technology, and more. Cast in gold, the medal includes a portrait of Sir Ivan, as well as the winner’s name and date of the award.

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Major Publications

• Magill I. Forceps for intracheal anaesthesia. Br Med J 1920; 2: 670 [Magill forceps]
• Rowbotham ES, Magill I. Anaesthetics in the plastic surgery of the face and jaws. Proc R Soc Med 1921; 14:17-27
• Magill I. A Portable Apparatus for Tracheal Insufflation Anaesthesia. Lancet. 1921; 197(5096): 918
• Magill I. The provision for expiration in endotracheal insufflations anaesthesia. Lancet 1923; 202(5211): 68–9.
• Magill I. An apparatus for the administration of nitrous oxide, oxygen, and ether. Lancet.1923; 202(5214): 228. 
• Magill I. An improved laryngoscope for anaesthetists. Lancet. 1926; 207(5349): 500 [Magill laryngoscope]
• Magill I. Improved anaesthetic apparatus. Lancet. 1927; 210(5425): 396
• Magill I. Endotracheal Anæsthesia. Proc R Soc Med. 1928; 22(2): 83–88.
• Magill I. Technique in endotracheal anaesthesia. BMJ. 1930; 2: 817–9. 
• Langton Hewer C, Magill I. Discussion on anaesthesia in thoracic surgery. Proc R Soc Med 1930; 23: 643
• Magill I. Anaesthesia in thoracic surgery with special reference to lobectomy. Proc R Soc Med 1936; 29: 643
• Magill I. Endotracheal anaesthesia. Am J Surg. 1936; 34(3): 450-455.
• Magill I. Endotracheal tube with inflatable rubber cuff. Medical Annual. 1939; 57: 27 [Magill ETT]
• Magill I. An appraisal of progress in anaesthetics. Ann R Coll Surg Engl. 1966; 38: 154–65.
• Magill I. The heritages of the past are the privileges of the future. Anaesthesiology. 1967; 28(1): 202–8
• Magill I. Blind nasal intubation. In: Lest we forget. Anaesthesia. 1975; 30(4): 476–490

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References

Biography

• Rowbotham S. Magill, Ivan W. Br J Anaesth. 1951 Jan;23(1):49-55. 
• Thomas KB. Sir Ivan Whiteside Magill, KCVO, DSc, MB, BCh, BAO, FRCS, FFARCS (Hon), FFARCSI (Hon), DA. Anaesthesia, 1978; 33(7): 628-634.
• Baskett P. The Resuscitation Greats. Sir Ivan Whiteside Magill KCVO DSc (Hon) Resuscitation. 2003 Nov;59(2):159-62.
• McLachlan G. Sir Ivan Magill KCVO, DSc, MB, BCh, BAO, FRCS, FFARCS (Hon), FFARCSI (Hon), DA, (1888-1986) Ulster medical journal, 2008 Sep; 77(3): 146-152
• Maltby R. Sir Ivan Whiteside Magill. In: Notable Names in Anaesthesia. The Choir Press; 2013: 123-125
• Sir Ivan Magill: Endotracheal Intubation. Association of Anaesthetists. 1976
• Bibliography. Magill, Ivan. WorldCat Identities

Eponymous terms

• White GMJ. Evolution of endotracheal and endobronchial intubation. Brit. J. Anaesth. 1960; 32: 235
• Chandler M. Tracheal intubation and sore throat: a mechanical explanation. Anaesthesia. 2002 Feb;57(2):155-61.
• Bateman BT, Alston TA. Commonly used eponyms in anesthesia. J Clin Anesth. 2009 Feb;21(1):67-71
• Yartsev A. The endotracheal tube in detail. Deranged physiology
• Sir Ivan Magill Gold Medal. Association of Anaesthetists
• Magill Laryngoscope. The Wood Library-Museum
• Adami F. History of cardiopulmonary resuscitation LITFL