Licence: In copyright
Credit: The gag / by G.H. Colt. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![abilities of occurrence. The instructions have been carried out by the makers of the instrument with the greatest care and they will insure by means of templets and bosses that the manufactured article is always an exact replica of the approved model. They will also supply the gag without the clutch or anaesthetic tube as may be required. The fitting and measurements for the experimental model were made in 500 jaws and the model was actually used in 220 cases, of which 160 were cases of operation on the nose and throat. By reason of its easy introduction and rela- tively large mechanical advantage it probably saved three lives in this series of 220 cases taken in a series of 1000 consecutive administrations. The three patients had fmcal vomiting during the early stages of chloroform anmsthesia in spite of a specially slow administration designed to prevent the occurrence of vomiting. Now in such case it is well- known that if the mouth can be opened quickly, the head turned on one side, the tongue controlled, and the vomit sponged quickly away the patient may recover and a calamity be averted. Usually the patient dies about three breaths after the regurgitation. Apparently the slight extra strain from vomiting followed by slight respiratory obstruction and possibly a rise of the intra- thoracic blood pressure are sufficient to cause an already exhausted heart to stop at once in diastole. It is needless to discuss the matter because no one can ever say absolutely that a patient who recovers would have died unless such and such a thing had been done, but the impres- sion left is that these patients would have died had not prompt remedial measures been taken. The final instrument may perhaps be shown to be imper- fect. This is inevitable in the evolution of a universal pattern of instrument for use in many different varieties of circumstances ; but it is an attempt in the right direction and as such I venture to bring it before the profession. Liston ® once advised his pupils at the North London Hospital “always to use their fingers, if possible, in preference to instruments, many of which were invented only for those whose fingers were useless. He [Liston] had endeavoured all his life to simplify modern treatment, apparatus, and, operations. To a great extent this holds true with respect to the gag. For special purposes the case is met by manual dexterity rather than by mechanical modifications of the instrument. s The Lancet, Jan. 17th, 1835, p. 598.](https://iiif.wellcomecollection.org/image/b22479855_0028.jp2/full/800%2C/0/default.jpg)
