Davis Gag

WLMD ID: amvk
For inhalation anesthesia, a gag may be used to keep a patient’s mouth open. In 1910, Edward C. Sewall, M.D. (1875-1957), published a description of a mouth gag which he designed, stating that it was a modification of the earlier Hartman gag.  Dr. Sewall’s gag caught the eye of anesthesiologist S. Griffith Davis, M.D.(1867-1934), who modified it further for use in tonsillectomies.  In 1912, a description of Dr. Davis’ gag was published by the prominent surgeon, Harvey W. Cushing, M.D. (1869-1939.) 

During a visit to the United States in 1921, the English anesthesiologist Henry E. G. Boyle (1875-1941) was impressed by the Davis gag, and bought one. He published two descriptions of it the following year, and again in the 1923 edition of his influential textbook.  It became better known as the Boyle, or Boyle-Davis, gag. 

Today the gag popularized by Boyle continues to be made by many equipment manufacturers. It consists of a frame that incorporates a handle, together with a selection of tongue depressors, called blades, in various sizes.  The paddle of depressor would hold the patient’s tongue and lower jaw, while the two, rubber-lined extensions at the top of the frame supported the patient’s upper teeth. From the 1920s through the 1990s, there have been at least 20 further modifications of the Davis gag.

 

Catalog Record: Davis Gag

Access Key: amvk

Accession No.: 2005-11-22-1

Title: [Davis Mouth Gag.]

Author: Davis, S. Griffith, 1867-1943.

Title variation: Alt Title
Title: Boyle-Davis Mouth Gag.

Publisher: [Philadelphia?] : [Penn Surgical Manufacturing Company?], [between 1912 and 1960?].
Physical Descript 1 mouth gag with four blades : metals, rubber, cotton or wool; 20 x 10 x 11 cm.

Subject: Airway Management.
Subject: Airway Management – instrumentation.
Subject: Anesthesia, Inhalation – instrumentation.
Subject: Surgery, Oral – instrumentation.
Subject: Surgical Instruments.
Subject: Tonsillectomy – instrumentation.

Note Type: General
Notes: For the brief physical description, the gag was measured with the size 4
blade inserted in the handle of the frame, and extended to its greatest
length.

The Penn Surgical Manufacturing Company, of Philadelphia, was chartered in
1906 and was found by the cataloger in published sources through 1959. The
earliest date in the date range is based on the date that Cushing’s
description was published. The latest date in the date range is based on the
latest published source in which mention of the manufacturer was found.

Note Type: Citation
Notes: Boyle HE. A combined gag and tongue retractor. Lancet. November 25,
1922;2:1130.

Note Type: Citation
Notes: Boyle HE, Hewer CL. Practical Anaesthetics. 3rd ed. London: Henry Frowde and
Hodder & Stoughton; 1923.

Note Type: Citation
Notes: Crowe SJ, Wattkns JS, Rothholz AS. Relation of tonsillar and nasopharyngeal
infections to general systemic disorders. Bull Johns Hopkins Hosp. January
1917;28:211:1-25.

Note Type: Citation
Notes: Cushing H The Pituitary Body and its Disorders. Philadelphia: Lippincott;
1912: 298.

Note Type: Citation
Notes: Maltby JR. Notable Names in Anaesthesia. London: The Royal Society of
Medicine Press; 2002.

Note Type: Physical Description
Notes: The gag consists of four separate parts, these being the frame and three
interchangeable tongue depressors; It is described here from the point of
view of the patient; Each tongue depressor (also called a blade) comprises a
straight handle with a long curved paddle at the top and a short curved
extension at the bottom; An integrated, open-ended tube runs over the top of
the paddle from front to back, and extends downward for 3 centimeters (cm),
ending in a port or nipple which can be connected to a hose for the
administration of oxygen or anesthetic gas; For the front two-thirds of its
length, the underside of the paddle is textured to grip the patient’s tongue;

The back of the handle of each depressor is scored with a row of indentations
which allow the handle to be adjusted up or down when inserted in the handle
of the frame; Immediately below this row of indentations, the largest blade
is marked “U.S.A. Chrome [new line] Penn [new line] 4”; In the same location,
the blade next in size is marked “U.S.A. Chrome [new line] Penn [new line]
3”; In the same location, the smallest blade is marked “Penn U. S.A. [new
line] Chrome [new line] 2; The curved extension at the bottom of the handle
prevents the depressor from rising beyond the top of the frame;

The frame comprises a C-shaped brace mounted on a short, straight handle; At
top of brace, facing the patient, there are two short, curved extensions;
Each extension is topped with a red rubber pad which is sewn in place with
string (either cotton or wool); When the frame is inserted in the patient’s
mouth, these extensions support the patient’s upper teeth;

On the front of the frame handle, there is a slot to accommodate a tongue
depressor, which is inserted with the indentations facing the frame handle
and the paddle facing forward; A lever is mounted on the back of the frame
handle; When the lever is depressed, a prong at the foot of the lever is
released, allowing the insertion or removal of a blade; When the lever is
released, the prong is seated through an opening in the handle, so as to
catch one or another of the indentations in the back of the blade, holding it
in place; Between the brace and the lever, the back of the handle is marked:
“Penn U.S.A.” [new line] Chrome”.

Note Type: Reproduction
Notes: Photographed by Mr. Steve Donisch, June 5, 2015.

Note Type: Historical
Notes: For inhalation anesthesia, a gag may be used to keep a patient’s mouth open.
In 1910, Edward C. Sewall, M.D. (1875-1957), published a description of a
mouth gag which he designed, stating that it was a modification of the
earlier Hartman gag. Dr. Sewall’s gag caught the eye of anesthesiologist S.
Griffith Davis, M.D.(1867-1934), who modified it further for use in
tonsillectomies. In 1912, a description of Dr. Davis’ gag was published by
the surgeon, Harvey W. Cushing, M.D. (1869-1939.)

During a visit to the United States in 1921, the English anesthesiologist
Henry E. G. Boyle (1875-1941) was impressed by the Davis gag, and bought one.
He published two descriptions of it the following year, and again in the 1923
edition of his influential textbook. It became better known as the Boyle, or
Boyle-Davis, gag. Today the gag popularized by Boyle continues to be made by
many equipment manufacturers. It consists of a frame that incorporates a
handle, together with a selection of tongue depressors (called blades) in
various sizes. From the 1920s through the 1990s, there have been at least 20
further modifications of the Davis gag.

Note Type: Exhibition
Notes: Selected for the WLM website (noted November 30, 2015).