Speculum

F. Chruchill, Traité pratique des maladies des femmes hors l'état de grossesse, pendant la grossesse et après l'accouchement, 1874, BIU Santé.

   Gynaecological abuse has its history. A lookback on the growth in speculum use.

   The speculum is a medical instrument designed to spread open the vaginal walls, thus freeing the gynaecologist’s hands to conduct their examination. This medical device is truly ancient since such instruments were found by archaeologists on sites at Pompei and Herculanum. However, the speculum had scarcely evolved thereafter. This may be explained by the fact that deliveries were conducted by midwives –women whose knowledge was passed on orally from generation to generation – relying on their hands rather than tools which were not available to them. A few physicians did, in rare occasions, conduct deliveries, mainly in attendance to queens or royal mistresses.

   The French Revolution marks the starting point to what may be called a gynaecological renaissance. In the beginning, knowledge of the female body became a priority. Accordingly, in 1794, the government would establish three medical schools training specifically in obstetrics. They were intended to address the growth in childbirth-related death, notably high in France. These schools taught vaccination, child delivery and favoured practicals which may be conducted on corpses or dummies or during deliveries. In 1802, Jean-Antoine Chaptal, a French politician and chemist created the school of midwifery of the Hospice de la maternité de Paris. In 1793 a law was passed to ensure the support of women in childbirth. The bill resulted from an alarming survey of birthing conditions at the time, for there were no maternity hospitals then. Deliveries were conducted in dedicated wards set within the hospitals; we know of their existence through archives. Now those wards were death-traps where the airflow was poor, while their vicinity with certain medical wards invited lethal infection. The schools set up in France were to advance the formation of a trained personnel thereby allowing for a fall in mortality rates.

   Subsequent to these reforms, the 19^th century marked a new leap forward for the speculum as a number of physicians modernised the tool towards easing clinical examination. In 1801, physician Joseph Récamier invented two types of speculum, one of them a full tube and the other known as a bivalve speculum. The latter was soon in use for its conical shape made its insertion straightforward and, made of tin, it allowed for a better lighting of the vagina. More speculums were created in the 19th century, designed by Guillaume Dupuytren and Ricord. Midwives would also contribute to the improvement of this instrument, like Marie-Anne Boivin, who created an additional curved top-end, helping to lessen the women’s pain upon insertion. This adjunct was also made of metal, allowing for more effective cleansing.

   These instruments, however, were not universally welcome for they are tricky to fit in and rather unpleasant for the patient. Out of consideration for women’s modesty, physicians frequently examined their female patient under a sheet or, alternately, she kept her clothes on. The use of a speculum was thus liable to offend these women’s delicacy and most doctors examined them by touch.

   A further development, Sim’s vaginal speculum, comes tainted with disregard for medical ethics. Surgeon James Marion Sims, considered the "father of modern gynaecology" stands today accused of acquiring enslaved women for the purpose of surgical intervention conducted without anaesthesia. He allegedly operated on these women without their consent, for, up until 1865, slaves rated as property. Best known among them, Mary Smith was operated upon more than 30 times by the surgeon.These operations made it possible for him to develop surgical techniques such as clitoridechtomy, a procedure consisting in the removal of all or part of the clitoris. In view of his baleful reputation the statue commemorating him has been removed from Central Park.

   In the 21^st century many women look askance at these outdated instruments which they find discomforting. Gynaecologists are equally excoriated for acts of gynaecological violence, for instance, when they bypass the patient’s assent to insert the said instrument.

Read more in the dictionary : Hymen - Caesarian section - Clitoris

Read the paper in French : Speculum