Notes: The first year in date range is based on the date of Jennings’ original description of the gag. The second year in the date range is based on the date that the gag was received by the WLM, but it’s fragility suggests that it is more likely to have been manufactured in the first half of the 20th century. Notes: Jennings JE. The complete removal of the tonsil in its capsule (Sluder method) by means of a new tonsillotome. Medical Fortnightly. 1914; 45:56-58. Interestingly, in early 1907, Colt already mentioned, that there were enough reasons for bringing forward the subject of a mouth gag designed to suit the needs of the general practitioner, surgeon, dental surgeon and anaesthetist. In those times, he already remarked besides the large number of different gags on the market, that a single perfect gag was missing, which supplies all needs [ 4].

Until now, mouth gags have been widely used in surgery. A variety of different mouth gags is described and distributed today (Table 1) [ 2– 5, 9]. Already Colt mentioned in 1907, that the number of gags in the market was large, but the number of those, which combine in one instrument all the essentials, is rare [ 4]. Many years later, on a Caribbean work trip, Dingman considered his mouth gag as “happiness” for a surgeon operating on cleft palate, but Millard stated in his book in 1976, that he experienced a couple of difficulties with that gag, mostly with its adaptability to fit to irregular alveolae [ 9]. Notes: Leow A-M, Lun-Jou L. Palatoplasty: evolution and controversies. Chang Gung Med J. 2008;31(4):335-345.For this purpose, the instrument features a slim wire design that easily accommodates to the face contour. In addition, the device is available in sizes that range from 10.5 to 16.5cm to accommodate pediatric and adult patients. Anesthesiologists are responsible for maintaining the patient's respiration and other vital functions during surgery. Mouth gags are sometimes used to hold the patient's mouth open for dentistry, oral surgery and anesthesia. In later times, mouth gags were used in medical situation to open the patients mouth for examination, insertion of instruments, administration of feeding or dental care. Sometimes this was necessary because of fear, but more frequently due to illness such as tetanus, epilepsy, stroke, hysteria, coma etc. [ 2]. Since the medical use of mouth gags, a wide variety of different mouth gags, with or without tongue depressors or plates, one- or double-sided, were invented and distributed [ 2– 10]. During clinical and surgical practice, the dislocation and sliding were less frequent observed in contrast to the original Denhart mouth gag. The Denhart–Hoefert mouth gag has been used in a large number of patients and has not encountered any trauma to the mandible or the teeth so far. After introduction in July 2008, the Denhart–Hoefert mouth gag was used in orthognathic surgery in 250 cases. It is regularly used in bisphosphonate-related osteonecrosis or bisphosphonate-related osteonecrosis risk patient surgery in 150 cases, because of its good controlled force application to the gingiva in edentulous jaw. Additionally, it has been used minimally in another 100 cases of other surgical operations. The Jennings gag is a modification of the gag introduced in the 1860s by William R. Whitehead, M.D. (1831-1902). Jennings removed the built-in tongue depressor of the Whitehead gag, and simplified the mechanism for opening and closing it. The Whitehead gag has two spring-loaded ratchets. The Jennings gag uses a single ratchet, located on the operator’s right, that can be manipulated by the finger and thumb of one hand. Squeezing the handles together opens the gag. To close it, the ratchet is depressed and the handles pushed apart. Both the Whitehead and Jennings gags are still being made today.

Anesthesiologists are responsible for maintaining the patient's respiration and other vital functions during surgery. Mouth gags are sometimes used to hold the patient's mouth open for dentistry, oral surgery and anesthesia. Surgical procedures for the repair of cleft palate began in the 18th Century. The first successful cleft palate surgery in the United States was performed in 1820 by John Collins Warren (1778-1856). Since the mid-19th Century, many mouth gags have been designed specifically for these surgeries. One was introduced in 1914 by St. Louis physician John Ellis Jennings (1863-1935). Notes: Austrian Difficult Airway/Intubation Registry, Virtual Museum of Equipment for Airway Management. http://www.adair.at/eng/museum/equipment/mouthgags/whiteheadobject01.htm. Accessed June 13, 2017. The “JS” logo stamped on the object is unknown to the cataloger. It is unlike the caduceus logo of the German manufacturer, Jetter & Scheerer.Notes: Whitehead, WR. Report on the best methods of treatment for different forms of cleft palate. Transactions of the American Medical Association, Volume XX. Philadelphia: Collins, 1869.