We return now to the gag’s more orthodox medical uses, which actually expanded in the second half of the nineteenth century and early twentieth century.
With the development of ‘inhalational’ anaesthesia by chloroform and nitrous oxide, the mouth gag acquires another level of importance in surgery and dentistry.
Oral surgeons and dentists were used to their patients being awake with sound airway reflexes. Now, oral cavities could be kept open wider and for much longer without the patient feeling discomfort, making procedures easier to perform.
However, anaesthesia increased the dangers of airway obstruction due to muscle relaxation, dislocation, or muscle damage. Moreover, early anaesthetics produced light and inconsistent results, increasing chances of spasms, choking and…bitten fingers for surgeons and anaesthetists!!
A 1907 article by GH Colt, senior anaesthetist at St Bartholomew’s Hospital, shows how important it became to find a reliable mouth gag design that would suit all the needs of general practitioners, surgeons, dental surgeons, and anaesthetists. Protecting the patient from subsequent additional damage was not a big concern yet, however: springs and ratchet catches were usually seen as the solution, or tongue depressors or plates added. The use of tongue forceps or pullers was also advised:
"Should the breathing stop during the administration of Nitrous Oxide Gas, or any other anaesthetic, the forcible pulling forward of the tongue, and the administration of nitrite of amyl within a few seconds after unmistakable signs of something unusual in the breathing have appeared, will in almost every case remove the difficulty." (Underwood’s notes on anaesthetics, as reported in Claudius Ash’s 1893 catalogue under ‘tongue forceps’).
More recent bilateral props reduce strain to TMJ and masticatory muscles more effectively, after lengthy dental or surgical procedures.
ADAQ’s historical collection includes a few old mouth gags that never fail to unsettle visitors who are non-dental professionals, and sometimes dentists too!
MOUTH PROPS
The simplest mouth props or gags were either made using vulcanite or lignum vitae, one of the hardest and most dense wood known, sometimes with soft rubber edges at the contact points with teeth. [ADAQ D76]
A long string was tied around the cinched waist, with the ends of the string left hanging out of the patient’s mouth, so that the gag could be retrieved easily if it dislodged. These gags were sold as early as 1875 by Claudius Ash & Sons, in three sizes, and were still available in the 1930s.
For anaesthesia, the prop was placed in the patient’s mouth, then the facepiece of the administering apparatus adjusted. A few inspirations of pure air before closing the stopcock would ‘beget confidence’ in the patient.
Lignum vitae (Guaiacum) originates from Central America. Some of its uses over time included: ship parts, truncheons for the British police, pulleys and wheel shafts, kitchen pestles, lawn bowls and croquet mallets. Lignum vitae resins were also used in medicine for syphilis, tuberculosis, and asthma; its extracts even featured in dentifrices and perfumes since the Renaissance, for its fragrance similar to sandalwood.
MAUNDERS SCREW GAG
‘For rapidly forcing open the mouth’, this screw-shaped appliance is credited by some to Austrian surgeon, Dr. Franz von Pitha (1810-1875). However, it commonly bears the name of Mr Maunders, who first described the use of a hard wood gag with helicoidal grooves in the 1850s.
It consists of a conical boxwood wedge with a helical spiral groove of increasing diameter and a distal holder (which is broken off in our gag). It is inserted between a gap in the front teeth.
Where contraction of the muscles of mastication is the result of an impacted wisdom tooth, occurring as it does in early life, the teeth at the front of the mouth are almost always firm and will bear the use of this instrument.
Metal Maunders screw gags are still available today, for use in procedures involving oral and nasal cavities.[ADAQ D227]
HEISTER’S MOUTH OPENER
A screw-like device appears in an illustration of the 1719 manual Chirurgie, by Lorenz Heister (1683-1758), a military surgeon who had treated many patients with tetanus. Heister recommends mouth openers and tongue depressors use for ‘spasms of the jaw’, as with tetanus or peritonsillar infections. [University of Queensland Collection]
The device maintains Heister’s name to this day, but it’s still unclear whether he actually devised the instrument himself.
In 1893, we find Claudius Ash & Co lists it simply as ‘mouth opener’, but for anaesthetics purposes: it was usually introduced where teeth were missing, but the thin blades could be ‘insinuated’ between clenched front teeth.
CROFT’S ADJUSTABLE SIDE GAG
This nickel-plated steel device shows one of the improvements made to the popular Mason’s adjustable side gag, which featured two curved shanks hinged together as a plier, with a ratchet-type mechanism across both and catch pin for release. The two concave cups accommodate the back teeth, in some versions these are coated in soft rubber. [ADAQ D362]