Jrom i?ie MEDICAL AMD SURGICAL RE TOR TER of September //lh, /SCO. 
DESCRIPTION 
OF A 
NEW UTERO-VAGINAL SPECULUM, 
ALBERT H. SMITH, M. D., 
lecturer on Obstetrics in the Philadelphia lylngforCharitj. 
The need of a vaginal speculum which would 
give more extended field of observation, and 
be applicable to a large range of cases, has 
probably been felt by every one who has 
treated diseases of the female reproductive 
organs, and it is scarcely likely that an instru- 
ment, which is perfect in its construction and 
applicability to all the various requirements 
of diagnosis and treatment, and which will 
combine in itself the advantages for all the 
various forms of specula, will ever he invented. 
■ ; * ... y* 
which is how so much in use, since the admi- 
rable modification of Cusco, viz., the dif- 
ficulty of examining in cases attended with 
great vaginal relaxation, from the tendency of 
the vaginal walls to encroach upon the field 
of view, and the impossibility of getting free 
access to the cervix with instruments and with 
the finger in cases requiring operative treat- 
ment. 
To obviate these difficulties a double vaginal 
retractor is needed ; and two instruments have 
been introduced to the profession with a view 
to this end, viz ; Sims’ duck-bill, and the “ new 
expanding ” speculum of Mr. Ellis, of London. 
The valve speculum, either bivalve or quadri- 
valve, has usually had the preference over the 
cylindrical, from the facility of introduction, 
its better retention by the vagina, and its more 
ready adaptation to various conditions of size 
and position of the cervix. For some purposes 
of treatment, especially, the cylindrical must 
always have an advantage, as in case of appli- 
cation of leeches, or of medicinal solutions, 
from the action of which the vagina should be 
protected; in cases in which no portion of the 
vagina should be exposed. 
In Sims’ speculum we have everything we 
require in such an instrument, by using two 
separate blades, introduced upon opposite 
sides of the vagina•, but this involves the ne- 
cessity of an assistant to hold each blade in a 
separate hand; and inasmuch as the assistant 
cannot have his eye upon the blade in its 
whole course, to enable him to hold it in the 
right direction, the operator must constantly 
correct the mal-position of the speculum. 
Two disadvantages, however, attend the 
valve speculum, and especially the bivalve, 
Mr. Ellis’ speculum, exhibited to the Lon- Description of a New litero- Vaginal Speculum. 
don Obstetrical Society in 1867, and described 
with the aid of a diagram in their transaction 
for that year, ingeniously attempted to over- 
come the difficulties above mentioned, by 
adapting to the principle of Cusco’s speculum, 
a mechanism by which the blades separated 
throughout their entire length, with a parallel 
movement, in addition to having the ordinary 
angular expansion of the bivalve. This in- 
strument is no doubt familiar to your readers. 
The mechanism, however, was clumsy and 
awkward, and probably for this reason the 
speculum has not come into use. To carry out 
this same idea, and produce the same move- 
ments, an instrument was described by Dr. 
Hough in the last number of Hays’ Journal, 
(July,) but which has nothing new in its action 
over Ellis’; it is even more complicated and un- 
manageable in its mechanism, Mr. Kolbehas, 
however, designed a speculum recently upon the 
same principle, which is exceedingly neat and 
simple in construction, fulfilling all the uses of 
Ellis’, and being very much lighter, and more 
easily managed, seems to me to be really a 
very admirable instrument—a vast improve- 
ment upon the old bivalve or Cusco’s. 
iug of this screw by a small milled wheel in the 
centre separates the slides, causing the center 
blades to recede in a parallel movement from 
the centre of the bar; and a contrary turn of the 
screw will again cause the pivots to approach 
each other. Thus, the parallel separation of the 
blade is brought about by the simple turning 
of a single screw, underneath the instrument, 
sufficiently out of the way not to interfere 
with its application nor increase its bulk ma- 
terially. The angular separation of the blades 
is made by means of small handles attached,, 
as in the ordinary valvular speculum, and the 
blades are retained in position by a screw and 
nut, similar in arrangement to that used in 
Cusco’s, except that each blade, moving upon 
an independent pivot, requires its own 
screw adjustment, this being attached to the 
slide upon which the blade moves in the par- 
allel separation. 
Fig. 1. Gives a profile view of the speculum 
closed for introduction, with the double-screw 
mechanism for the parallel separation of the 
blades. 
This speculum, however, having its vulvar 
aperture a closed ring, does not allow access 
to the uterus with the finger in operative cases. 
About a year ago, before either of the last 
two mentioned were proposed, I suggested to 
Mr. Kolbe to make for me a speculum which 
would combine the double movement of El- 
lis’—that is, the parallel and angular move- 
ment, with the shortness of blade and entire 
separation at the vulva secured by Sim’s ; hav- 
ing an advantage over the latter in being self- 
retaining. 
Fig. 2. Shows the instrument from above, 
after the blades have been separated, in par- 
allelism, without any change in their angle to 
each other. 
The instrument, as constructed, is light and 
neat; simple in its mechanism, and easily 
managed. The blades are three and one-fourth 
inches in length, and one and three-eighth 
inches wide. Instead of being connected by 
a ring at the vulvar end, they are entirely sep- 
arate ; each one moving independently upon its 
own pivot; the two pivots being fixed upon 
slides, which move in turn upon a fenestrated 
bar. These slides are made to fit accurately 
upon the bar, so that a steady movement in 
the separation of the blades is secured; this 
movement is effected by means of a double 
(or right and left) screw placed under the bar, 
and passing through nuts in the lower extrem- 
ities of the pivots upon which the blades ro- 
tate. 'When the instrument is closed, the turn- 
Fig. 3. Shows the instrument with the 
simple angular separation, used as an ordinary 
two-valve. 
Another view might be shown, but is hardly 
necessary, with both the parallel and angular 
movements combined. It is merely needed to 
say that both movements may be made to the 
full extent, and the instrument so adapted as Description of a New Utero- Vaginal Speculum. 
to produce an equable and uniform distension 
of the vagina throughout the whole length. 
It may be introduced with the bar and screw 
toward the side of the pelvis, the convexity of 
the blade being antero-posterior; or again with 
the convexity presenting laterally, the bar 
being in front of pelvis, a position especially 
useful in surgical operations upon the cervix, 
and enables the finger to be carried over the 
perineum between the separated blades and 
brought in contact with the cervix. 
tionof the uterine sound, the uterus being more 
nearly in its natural position, and not forced 
backward as is the case when the long, closed 
speculum is used. 
The instrument, as gotten up by Mr. Kolbe, 
is neat, light and portable; the only change in 
it which can be suggested so far after consider- 
able use, is the substitution of a flat screw 
head at the end of the double screw, instead 
of the milled wheel in the middle, as giving a 
more effective grasp for the parallel separa- 
tion of the blades. 
The shortness of the blades and the full 
separation anteriorly is proved by experience 
in the considerable number of cases in which 
I have used it already, to permit the uterus 
to fall forward and approach the vulva, mak- 
ing it perfectly accessible; an advantage which 
every one will appreciate, especially in cases 
requiring operation, such as the introduction 
of sponge tents, the ligature or excision of 
polypi, or any other procedure when the touch 
would increase the accuracy of operation. 
Much greater facility is given for the introduc- 
The peculiarities of this speculum, which, so 
far as I am aware, are new, are the parallel 
movement by means of the right and left 
screw, the entire distinctness of action of the 
blades by placing them upon separate pivots, 
moving independently of each other, and the 
openness' of the vulvar extremity upon both 
sides, differing from all other forms of valve 
speculum, and affording access to the uterus 
by the finger, and for examination of all por- 
tions of the vaginal tissue. 
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