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Speculum (medicine)

Medical device for investigating body orifices by direct vision

  • 5 min read
  • 4 chapters
Speculum (medicine)
Unknown author · CC BY-SA 2.0 fr

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History

History of instrument

Vaginal and anal specula were used by the ancient Greeks and Romans, and speculum artifacts have been found in Pompeii.

A more modern vaginal speculum was developed by Marie Boivin (1773–1841), a French midwife, inventor, and obstetrics writer who has been called one of the most important women in medicine in the 19th century.

Another vaginal speculum was developed by J. Marion Sims, a plantation doctor in Lancaster County, South Carolina. Between 1845 and 1849, Sims performed dozens of surgeries, without anesthesia, on at least 12 enslaved women. In these experiments, Sims developed a technique to repair fistula and in the process invented the Sims' vaginal speculum. These experiments, and the development of the modern specula, led some to regard Sims as the "father of modern gynaecology." The Sims speculum was originally made from a pewter spoon bent into a shape similar to the beak of a duck. It had no hinges or screws.

The modern two-billed (bivalve) speculum was invented by Edward Gabriel Cusco in 1870, the Cusco's speculum. This speculum consists of a hollow cylinder with a rounded end that is divided into two hinged parts. This speculum is inserted into the vagina to dilate it for examination of the vagina and cervix. T.W. Graves combined the Cusco design with Sims' duckbill shape, producing Graves' duckbilled speculum, the design most commonly used today.

History of use

By the 1860s, specula were integrated into criminal justice practices in the UK. In Great Britain, examinations of the cervix were made mandatory for all women convicted of prostitution by the country's Contagious Disease Act. In the 19th century, the vaginal speculum became a cultural symbol of the tenuous relationship between women and their physicians. Use of the speculum was generally avoided in medical practices, and most vaginal conditions were diagnosed through symptoms or palpating the abdomen. Many practitioners had moral concerns about the use of the speculum, and preferred to diagnose through palpating the abdomen. As late as 1910, physicians believed the vaginal speculum to be inferior to the "educated touch."

These concerns continued into the early 20th century as the speculum became commonplace in gynecology practices. Often, nurses played a major role in ensuring the proper use of the speculum during medical exams. The 1946 and 1956 editions of a multi-volume gynecology text for nurses required that nurses remain present during examination to protect both the patient and physician from "blackmail by designing persons."

As of 2015, 85% of gynecologists are women. As a result of this demographic shift, the procedures around speculum use have also changed.

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