Vulcanite & Von Pitha Gags

WLMD ID: akwg & akwh
A variety of implements have been used to keep a patient’s mouth open for dentistry, oral surgery, and anesthesia. The Austrian surgeon, Dr. Franz F. von Pitha (1810-1875) introduced the first screw-shaped mouth gag in the late 1860s. This simple design could be placed anywhere between the jaws and left there as a prop. It could also be turned to gradually open the patient’s mouth wider. “Mouth screws” were in common use for nearly a century, and are still available today. Props like that on the left were carefully shaped to fit between the teeth in the upper and lower jaw. This example is made of vulcanite, a hard form of rubber that could withstand compression. 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 came loose. This gag was advertised in 1875 by Claudius Ash & Sons, a dental equipment maker. Similar props were sold through the 1930s.

Catalog Record: Vulcanite & Von Pitha Gags

Two catalog records: akwg & akwh

Access Key: akwg
Accession No.: 2012-12-11-1

Title: [Vulcanite gag.]

Title variation: Alt Title
Title: Vulcanite mouth prop.

Title variation: Alt Title
Title: Vulcanite mouth gag.

Title variation: Alt Title
Title: Mouth-prop.

Title variation: Alt Title
Title: Hourglass mouth prop.

Publisher: [Place of manufacture not indicated] : [Name of manufacture not indicated], [betwen 1870 and 1940].

Physical Descript: 1 mouth gag : vulcanite ; 4 x 2 x 2 cm.

Subject: Mouth Gags.
Subject: Anesthesia, Dental – instrumentation.
Subject: Airway Management – instrumentation.
Subject: Airway Management Equipment.

Note Type: General
Notes: Title based on the WLM common name for the object.

Note Type: General
Notes: Yearly year in the date range for the possible year of manufacture is based
on the earliest published image and description of such a prop (Davidson,
1973). The late year is based on a skimming of anesthesia textbooks with and
without images or likely descriptions. The most recent publication found with
an image and description of these kind of mouth props was a 1935 book by
dentist Sterling V. Mead. The date range could change if documentation that
indicates the dates should be corrected is discovered.

Note Type: Citation
Notes: Buxton DW. Nitrous oxide gas. Anaesthetics: Their Uses and Administration.
3rd ed. London: K.K. Lewis; 1900:78-88. https://babel.hathitrust.
org/cgi/pt?id=uc1.31378007483780;view=1up;seq=13. Accessed August 3, 2014.

Note Type: Citation
Notes: Coleman A. Anaesthesia. In: Stellwagen TC, ed. Manual of Dental Surgery and
Pathology. Revised ed. Philadelphia: Henry C. Lea’s Son & Co.; 1882:331.
https://archive.org/details/manualofdentalsu00cole. Accessed August 3, 2014.
[Contains an image of hourglass shaped mouth props made of wood or vulcanite]

Note Type: Citation
Notes: Davidson G. Mouth-prop for use with nitrous oxide. Brit J Dent Sci. March,
1873;16(201):108. https://books.google.
com/books?id=q4g1AQAAMAAJ&printsec=frontcover#v=onepage&q&f=false. Accessed
July 30, 2014. [In this short description with an illustrations Davidson
reports having used the vulcanite mouth gags or props for eighteen months.
An illustration accompanies the short description. Although they are not
exactly alike (he describes “corrugated soft rubber tops”, and the center has
a ‘corseted’ shape rather than hourglass) they are very similar to later
vulcanite props like the one described here.]

Note Type: Citation
Notes: Gags or mouth-props. A Catalogue of Artificial Teeeth, Dental Materials,
Instruments, Tools, Furniture, &c. 2nd ed. London: Claudius Ash & Sons;
1880:187,190. Accessed August 3, 2014. https://books.google.
com/books?id=9UhIAAAAMAAJ&printsec=frontcover#v=onepage&q&f=false. Accessed
August 3, 2014. [Contains an image of hourglass shaped mouth props made of
wood].

Note Type: Citation
Notes: Luke TD, Ross JS. The choice of anaesthetic. In: Anaesthesia in Dental
Surgery. 4th ed. St. Louis: C.V. Mosby Company; 1920:36-38. https://archive.
org/details/anaesthesiainden00luke. Accessed August 3, 2014. [Contains
illustrations of a number of mouth gags and props, including “vulcanite
props”.]

Note Type: Citation
Notes: Mead SV. Armamentarium for general anesthesia. Anesthesia in Dental Surgery.
St. Louis: C.V. Mosby Company; 1935:182-187.

Note Type: Citation
Notes: Nitrous oxide gas and apparatus. A Catalogue of Surgical Instruments and
Apparatus, Manufactured and Sold by Jas. Coxeter & Son. London: Coxeter;
1870:120. https://books.google.
com/books?id=QulcAAAAcAAJ&printsec=frontcover#v=onepage&q&f=false. Accessed
July 30, 2014. [This catalog lists a set of six “Vulcanite mouth-props” but
there is not a description or illustration.]

Note Type: Citation
Notes: Thomas FR. Inhalers and accessary apparatus. In: Manual of the Discovery,
Manufacture,a nd Administration of Nitrous Oxide, or Laughing Gas, In Its
Relations to Dental or Minor Surgical Operations, and Particularly for the
Painless Extraction of Teeth. Philadelphia: S.S. White; 1870:76.
https://archive.org/details/manualofdiscover1870thom. Accessed August 3, 2014
[Contains an image of hourglass shaped mouth props made of wood].

Note Type: Citation
Notes: Underwood AS. Appendix: mouth gags. In: Notes on Anaesthetics. 1st ed.
London: Claudius Ash and Sons;1885:110-113. https://books.google.
com/books?id=MUlIAAAAMAAJ&printsec=frontcover#v=onepage&q&f=false. Accessed
August 3, 2014. [Includes an image of a number of gags, including an
hourglass gag made of vulcanite that looks very much like the one described
here.]

Note Type: Citation
Notes: Vulcanite. Plastics Historical Society website. https://www.plastiquarian.
com/index.php?id=41. Accessed July 30, 2014.

Note Type: Physical Description
Notes: One mouth prop made of a hard rubber, such as vulcanite or a vulcanite-like
material; Measuring tooth-end to tooth-end at the longest points it measures
approximately 3.8 cm in height; It measures approximately 1.6 cm in width and
depth; The measurement were taken from the perspective facing a patient
sitting up with the prop in place, between molars of the upper and lower jaw;
It is hourglass shaped with the central body of the prop being black hard
rubber; The ends have a convex shape, to slightly cradle the teeth, and are
made of a firm bust softer red rubber; The prop is in good condition with
just some wear from age and handling; There are no manufacturer markings.

Note Type: Reproduction
Notes: Photographed by Mr. Steve Donisch in September, 2013.

Note Type: Historical
Notes: Before gags of this shape were made of vulcanite (an early rubber) they, or
similarly shaped gags, were made of wood. This type of gag or mouth prop was
placed so that the ‘top’ and ‘bottom’ of the ‘hourglass’ were in contact with
a tooth in the upper and lower jaw. They were often used in pairs, one on
each side of the jaw. A string was tied to the center of both gags and left
hanging below the jaw to prevent the gags from being swallowed or inhaled.

Patients who were under light nitrous oxide, chloroform or ether anesthesia
sometimes clenched their mouths closed as a reflex. Also, during anesthesia
the throat and jaw muscles relax, sometimes causing the airway to the lungs
to become obstructed. For these reasons, mouth gags were sometimes used to
keep the mouth and airway open and accessible during anesthesia.

There were countless designs for mouth gags, but the simple hourglass shape
was especially popular. Dr. Arthur S. Underwood (1854-1916), a London dental
surgeon and author of the 1885 text Notes on Anaesthetics, believed that
these vulcanite gags satisfied all of his requirements for a mouth gag: small
in size, secure, and easy to clean. He also liked the fact that they were
available in several sizes.

As the practice of anesthesia advanced, the use of mouth gags for airway
maintenance lessened. They are still used today for procedures and surgeries
involving the mouth and throat.

Note Type: Publication
Notes: Goldman JD. Oral surgery, exodontia, and anesthesia: better and safer
gas-oxygen anesthesia for exodontia. Dent Items Interest. April,
1945;64:358-372. [On page 365 of this article is an illustration of a patient
sitting in a dental chair with a vulcanite/hourglass mouth prop in one side
of her mouth. The other side dangles from the mouth.]

Note Type: Exhibition
Notes: Selected for the WLM website.

Access Key: akwh
Accession No.: 2002-02-07-1 B

Title: [Von Pitha screw.]

Author: Pitha, Franz Freiherr von, 1810-1875.

Title variation: Alt Title
Title: Von Pitha mouth gag.

Title variation: Alt Title
Title: Von Pitha mouth screw.

Title variation: Alt Title
Title: Screw wedge.

Title variation: Alt Title
Title: Maunder’s screw wedge.

Title variation: Alt Title
Title: Screw gag.

Publisher: [Place of production not identified] : [producer not identified], [between 1860 and 1910].

Physical Descript: 1 mouth gag : wood ; 4 x 4 x 13 cm.

Subject: Mouth Gags.
Subject: Airway Management – instrumentation.
Subject: Airway Management Equipment.
Subject: Anesthesia, Dental – instrumentation.
Subject: Trismus – therapy.
Subject: Otorhinolaryngologic Surgical Procedures – instrumentation.

Note Type: General
Notes: The date range is a broad estimate based on von Pitha’s birth and death dates
and years of professional activity, and well as the dates of journal articles
and books that refer to von Pitha-like mouth screws (as found in Google Books
Google Scholar, the Internet Archive, and and broad internet searches for
German literature. The date range could change if new documentation indicates
that it should be corrected.

Note Type: General
Notes: The title is based on the WLM common name for the object; The alternate
titles were taken from various references to the “von Pitha gag”; A very
similar looking gag, Maunder’s screw wedge, is also included because of the
similarity with gags referred to as von Pitha, and because of the wide range
of screw and wedge like gags that are commonly referred to as von Pitha.

Note Type: Citation
Notes: Hermann Katsch. Haupt-Preisliste. München: Hermann Katsch; 1906:142.
https://vlp.mpiwg-berlin.mpg.de/library/data/lit61/index_html?pn=143. Accessed
July 24, 2014. [includes a “Mundkeil von Buchsbaumholz” (boxwood mouth wedge)
that looks like a version of what is commonly called a von Pitha Mouth Screw.
It also includes a “Mundkeil nach Pitha” (mouth wedge by Pitha), a
rectangular bite block, which is referred to as “Pitha’s Mouth Wedge” and a
“Pitha Mouth Prop” in other resources.]

Note Type: Citation
Notes: Surgical diseases connected with the teeth and their treatment. In: Holmes T,
Hulke JW, eds. A System of Surgery: Theoretical and Practical in Treatises by
Various Authors. 3rd ed. Vol 2. London, Longmans, Green, and Co.; 1883:454.
[Describes a mouth screw, Mr. Maunder’s ‘gag’, that is very similar to the
von Pitha mouth screw described here.]

Note Type: Citation
Notes: Kirkup J. Organic materials. In: The Evolution of Surgical Instruments: An
Illustrated History from Ancient Times to the Twentieth Century. Novato,
California: Norman Publishing; 2006:87. [Page 87 includes an image to a
“Maunder’s screw wedge”.]

Note Type: Citation
Notes: Mundsperrer (2) frz. “poire d’angoisse”. Museum Sybodo website. https://www.
kugener.
com/de/humanmedizin-en/anaesthesie/47-artikel/63-mundsperrer-2-frz-poire-d-an
oisse.html. Accessed July 24, 2014.

Note Type: Citation
Notes: Pitha mouth gag (manufacturer unknown, object number 1). Virtual Museum of
Equipment for Airway Management website. https://www.adair.
at/eng/museum/equipment/mouthgags/pithamouthgag/object01.htm. Accessed July
24, 2014. [This gag attributed to Pitha is triangular shaped and knotched on
two sides. The profile resembles a Christmas Tree on a handle.]

Note Type: Citation
Notes: Schulte am Esch, Jochen, Goerig M. Anaesthetic equipment in the History of
German Anaesthesia. Lu¨beck : Dra¨ger, 1997:57. [On page 57 are images of a
number of gag all referred to as “models of Pitha”. They represent a wide
range of shapes and sizes.]

Note Type: Citation
Notes: von Esmarch F, Kowalzig E. Surgical technic: A Text-Book on Operative Surgery
New York: Macmillan Company; 1901:693-696. https://books.google.
com/books?id=mhgW9-hNMfYC&printsec=frontcover#v=onepage&q&f=false. Accessed
July 25, 2014. [On page 581 is an illustration, labeled “Screw Wedge”, of
what is commonly called a von Pitha mouth screw. On the following page is an
illustration labeled “Pitha’s Mouth Wedge”.

Note Type: Physical Description
Notes: One mouth screw made of wood; Shaped like a cone in which the surface is cut
to form a spiral thread; The measurements recorded in the Physical
Description field are based on the perspective of a patient looking at the
narrow end; The ‘tip’, or most proximal end measures approximately 7 x 11 mm;
It widens to a round distal end measuring approximately 3.7 cm in diameter;
The last 1.1 cm of the end is not threaded; It is smooth except for 16 thin
and worn grooves that may have provided some grip when turning the mouth
screw; There is some chipping (about 6 significant spots) of the threading
along the cone, and the wood is slightly soiled from wear and age; There are
no maker markings on the item.

Note Type: Reproduction
Notes: Photographed by Mr. Steve Donisch in September, 2013.

Note Type: Historical
Notes: A number of mouth screws and wedges are commonly attributed to Franz von
Pitha (1810-1875). After earning his medical degree in 1836, von Pitha became
professor of surgery at Charles University in Prague. From 1857 to 1874 he
was chair of surgery at Joseph’s Academy in Vienna. During this time he
published an important multivolume surgical text, the Handbuch der
allgemeinen und speciellen Chirurgie, with Theodor Billroth (1829-1894), who
is known today as a pioneer of abdominal surgery. The first volume was
printed in 1865.

The threaded, cone shaped, wooden mouth screw described here was used to
assist in opening a patient’s mouth that was shut tight due to swelling or
muscle spasms around the jaw. The tip of the screw was placed between the
premolars or canines, or wherever there was a small space that could
accommodate it. Once wedged into a suitable spot, the wooden screw was turned
so that it gradually opened the mouth. After the mouth was open, the screw
might have then been replaced with a block-like wedge, or left in place for
the duration of the exam and surgical procedure.

Note Type: Publication
Notes: Wayand W, Feil W, Skopec M. Surgery in Austria. Arch Surg. February,
2002;137(2):217-220.

Note Type: Exhibition
Notes: Selected for the WLM website.