Page:The New System of Gynaecology Vol 1.djvu/169

SPECULA 157 retractor is introduced too deeply. This is a mistake, inasmuch as it pulls upon the attachments of the cervix and tends to displace this structure. At times, also, the anterior vaginal wall bulges unduly into the passage and obstructs the view of the parts above. If this is the case, it should be pressed forward with an anterior blade or spatula. The speculum may also be employed when the patient is placed in the lithotomy position, as shown in Fig. 87. This, in fact, is the usual procedure when any operation is contemplated upon the cervix or uterine body by the vaginal route. The mode of introduction of the speculum in this position is in essential

details the same, care being taken to introduce the broad diameter of the blade in the long axis of the vulva to avoid the production of any laceration of the vulval mucosa. Many modifications of this instrument have been devised by different surgeons. The most important are those of Simon, Auvard, Pozzi, and Doyen.

Simon s speculum consists of two separate blades, each mounted on a solid slightly curved handle. The posterior blade is concave, whilst the anterior is flat. In the case of the latter, the curve of the handle is more accentuated in order to avoid the prominence due to the symphysis pubis. The speculum is made in various sizes, but in all cases care should be taken to see that the blades are sufficiently