Magill forceps

The forceps were developed by Ivan Whiteside Magill (1888–1986) at the Queen’s Hospital for Facial and Jaw Injuries, Sidcup, in 1920 as an alternative to the guiding rod of his colleague Edgar Stanley Rowbotham (1890-1979)

Modern use

Magill forceps remain in clinical use for:

• guiding a nasotracheal tube through the glottis during direct laryngoscopy
• directing nasogastric or orogastric tubes into the oesophagus
• removing foreign material from the pharynx or upper airway
• positioning or removing pharyngeal packs

Description

Modern Magill forceps are scissor-handled, angulated forceps designed so that the operator’s hand and the shaft of the instrument remain outside the direct line of sight during laryngoscopy.

The distal jaws are blunt and curved for atraumatic grasping of tubes or foreign material. Reusable and disposable versions are available in adult and paediatric sizes, with variations in jaw design according to intended use.

The characteristic bend remains the defining feature: it permits manipulation within the oropharynx while maintaining an unobstructed view of the larynx.

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Development of the Magill forceps

1920 – On October 16, Stanley Rowbotham published Intratracheal anaesthesia by the nasal route for operations on the mouth and lips. His technique involved passing a catheter through the nose, identifying it in the oropharynx with a laryngoscope, engaging its distal opening with a specially shaped metal guiding rod, and directing the catheter through the vocal cords.

The method provided tracheal anaesthesia while keeping the anaesthetic tubing away from the operative field during facial and oral surgery.

1920 – Later that month, Ivan Magill published Forceps for intracheal anaesthesia, proposing an alternative method to Rowbotham’s technique for controlling the nasal catheter.

Magill’s forceps were manufactured for him by Meyer and Phelps. They measured approximately 6½ inches in length and incorporated an angular bend designed to clear the operator’s field of vision.

The distal jaws formed a longitudinally divided cylinder with serrated inner surfaces, allowing the catheter to be securely grasped without damaging its end.

Magill compared his forceps with Rowbotham’s guiding rod. He noted that the catheter could be picked up more easily within the oropharynx; the grasp remained secure without maintaining external tension on the catheter; the forceps could be used alongside or within the laryngoscope; and the operator’s visual field remained clear.

Modern Magill forceps. The basic geometry has changed remarkably little. Modern Magill forceps retain the characteristic angulation introduced to permit manipulation of tubes and other objects under direct laryngoscopic vision.

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Eponymythology

Magill published the instrument descriptively as “Forceps for Intratracheal Anaesthesia” rather than naming it after himself.

The term Magill forceps was later applied eponymously and remains in widespread clinical use more than a century after the original description.

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Associated Persons

• Edgar Stanley Rowbotham (1890-1979)
• Sir Ivan Whiteside Magill (1888-1986)

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References

Historical references

• Rowbotham S. Intratracheal anaesthesia by the nasal route for operations on the mouth and lips. Br Med J. 1920 Oct 16;2(3120):590-1.
• Magill IW. Forceps for intracheal anaesthesia. Br Med J 1920;2:670

Eponymous term review

• 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 Med J. 2008 Sep;77(3):146-52.