attached to the handle, which can be fastened in the pillow, sheet, or patient's dress: the cervix is drawn down with a volsella held in the one hand, leaving the other free for minor manipulation.

Theory of action and uses of the Sims Speculum.-The Sims speculum is based on the effects consequent on the genupectoral posture. When the patient is semiprone and the vaginal orifice opened, the segments of the pelvic floor separate; and then the Sims speculum is a simple means of hooking the sacral segment well back.

Its

In

The Sims speculum is, on the whole, by far the most useful speculum. It is difficult to manipulate at first, but amply repays practice. discovery has been one of the greatest strides in gynecology. vaginal and cervical operative surgery, it is the only speculum that can be used.

2. The FERGUSSON SPECULUM is seen at fig. 85. It is made in three

suitable sizes; and may be described as a glass tube, with a proximal trumpet and a distal bevelled end. It is made of glass silvered internally and coated on the outside with caoutchouc. The bevelling of the distal end makes a shorter anterior side and a longer posterior The maker's name is usually placed at the trumpet end just at the foot of the anterior side, and serves to indicate that side when the speculum is in the vagina.

one.

Mode of employment of the Fergusson Speculum.-The patient lies in the left lateral position with hips raised. Warm the speculum, and oil it on the outside. Take it by the trumpet end with the right hand and pass it into the vaginal orifice previously opened up by index and

middle fingers of the left; now push it in, short side to the front, until arrested. By looking along it, the practitioner can note if the cervix is in view. It is generally not so, but may be snared by the following manoeuvres; carry the trumpet end well back towards the perineum and then depress the distal end first to the left and then to the right, finally turning it round if these fail. In multiparæ with lax vaginae it is easy to pass the Fergusson; but it is more difficult in nulliparæ.

The Fergusson is a favourite speculum with many. It is useless in vaginal and cervical surgery, but with it applications to the cervix can be made very well and easily. When used for making applications to the endometrium, it is advisable to pull the cervix well down with a volsella after the speculum is passed, and to use a straight sound covered with cotton wool.

3. The NEUGEBAUER is like a Sims speculum divided transversely at the middle of the handle (fig. 86). It is also made in suitable sizes.

Mode of employment.-Warm and oil two blades. Introduce one blade (the broader one) with its convexity touching the posterior vaginal wall. Then introduce the other with its convexity touching the anterior

vaginal wall and so that its edges fit within the edges of the posterior vaginal wall blade (fig. 87). The beak of the posterior blade is thus

Fig. 88.

Barnes' Crescent Speculum.

in the posterior fornix; that of the anterior blade in the anterior fornix. From their contact a leverage is obtained on separating the

Fig. 89.

Cusco's Speculum.

handles, by which traction is made on the fornices and the cervical canal

more or less everted.