6.DGÖR÷lu, O. Ögenler, ø. Uzel History of Medicine A Classical Wooden Vaginal Speculum Mentioned in Old Medical Manuscripts 6HOLP.DGÕR÷OX0'3K'12\DgJHQOHU0'3K'ƔøOWHU8]HO0'3K'3 Abstract 7KHVXEMHFWRIWKLVSDSHULVWKHVWRU\RIDQDQFLHQWPHGLFDOLQVWUXPHQW7KLVLQVWUXPHQWLVDZRRGHQYDJLQDOVSHFXOXPXVHGLQFODVVLFDODQG ,VODPLFPHGLFLQH,WVGUDZLQJVFDQEHIRXQGLQ$EXOFDVLVDO=DKUDZL¶VDQGùHUHIHGGLQ6DEXQFXR÷OX¶VLOOXVWUDWHGERRNVRIVXUJHU\ Keywords:+LVWRU\RIJ\QHFRORJ\DQGREVWHWULFVKLVWRU\RIPHGLFLQHKLVWRU\RIPHGLFDOLQVWUXPHQWV Cite this article as: .DGÕR÷OX6gJHQOHU28]HOø$FODVVLFDOZRRGHQYDJLQDOVSHFXOXPPHQWLRQHGLQROGPHGLFDOPDQXVFULSWVArch Iran Med. 2017; 193 – 195. Introduction In the 6th FHQWXU\ $HWLXV RI $PLGD >th century] mentioned the vaginal speculum in his works. In the 7th century, Paulus of he word speculum, Latin for “mirror”, is used for devices $HJLQD>FLUFD±@QRWHGHPSOR\LQJWKHYDJLQDOVSHFXOXP T that allow us to examine and treat tubular body parts with a for diagnosis and treatment of cervical diseases and described the OXPHQORFDWHGEH\RQGLQWURGXFWRU\RUL¿FHVE\SXVKLQJWKH medical procedures for treatment of cervix uteri using this device. walls apart from the inside.1 Vaginal speculum is the most In the Islamic medicine, Ali ibn Abbas Majusi Ahvazi (Hally commonly used type. A vaginal speculum enables us to see the $EEDV >FLUFD ± @ GHVFULEHG KRZ WR XVH WKH VSHFXOXP cervix uteri, rendering possible the diagnostic and therapeutic in situations related to gynecological diseases and childbirth. processes related to that part and the inside of the uterus. ,QKLVERRNøEQ6LQD $YLFHQQD >FLUFD±@UHIHUUHGWR Vaginal speculum, the main instrument of gynecological XVHRIDPLUURUUHÀHFWLQJWKHOLJKWZLWKDYDJLQDOVSHFXOXPIRU H[DPLQDWLRQ KDV D ORQJ KLVWRU\ UHÀHFWLQJ WKH FRHYROXWLRQ RI WKH ¿UVW WLPH DQG H[SODLQHG WKH V\PSWRPV DQG WUHDWPHQWV RI medicine and medical technology. It is an interesting device with gynecological diseases.8 All the authors note that the size of the a multitude of variations from the past to the present. The oldest vaginal speculum should be chosen based on the patient’s age and example of vaginal speculum was found in a surgeon’s house body type. Authors also mention that the vaginal speculum is used in Pompei, which is now in Naples National Archaeological in surgical treatment of lesions located in the vagina and cervix Museum.2,3 Today, the parts of the vaginal speculum entering into uteri such as abscesses and tumors.5–7,9 the vagina and spreading it apart consist of two pieces, whereas 7KH¿UVWGUDZLQJRIDYDJLQDOVSHFXOXPZDVLOOXVWUDWHGLQWKH three-piece models were used in the past. A bronze speculum was “Kitab At-Tasrif (On Surgery and Instruments)” of Abulcasis Al- found in Anatolia and published by Kunzl, which was an assembly =DKUDZL>FLUFD±@7KHERRNFRQWDLQVVRPHLQIRUPDWLRQ of screws, a typical example of these instruments.3 on vaginal speculum such as its material, list of the diseases which The use of the speculum was mentioned in the works of indicate its use, and the positions of the woman for its application.9 +LSSRFUDWHV >FLUFD ± %&@ LQ JHQHUDO WHUPV +RZHYHU Al-Zahrawi gathered the surgical information presented by 6RUDQXVRI(SKHVXV>FLUFD±@ ZDVWKH¿UVWZKRVSHFL¿FDOO\ Hippocrates and by integrating it with his own experiences, he mentioned the vaginal speculum.4,5 Soranus described the vaginal presented them in a realistic way in his work At-Tasrif.9 Unlike the speculum in a detailed way in Gynaikeia.5 In this book focusing text-only style of classic writers, drawings of surgical instruments on obstetrics, even though some drawings are present, none ZHUHXVHGIRUWKH¿UVWWLPHLQKLVZRUN1DPHO\KHZURWHWKH¿UVW of them shows the vaginal speculum.5 The use of the vaginal textbook, including drawings of medical tools in the history of speculum, which started as part of the traditional Greco-Roman medicine. He drew tools such as scissors, syringes, scalpel, and medicine, continued with the Islamic medicine pursuing the same vaginal speculum, while also mentioning the application of these tradition. Vaginal speculum was then called by odd names such tools.9 as “diopter”, “katopter”, “lawlab” (screws) and “miftah-ul ferc” Andalusian surgeon Al-Zahrawi is the symbol of the high (vulva opener).5–7 VFLHQWL¿F OHYHO DWWDLQHG E\ ,VODPLF PHGLFLQH LQ (XURSH LQ WKH Middle Age. Since his contributions improved the level of surgery $XWKRUV¶DI¿OLDWLRQV 1Department of History of Medicine and Medical Ethics, IURPDVLPSOHFUDIWWRDUHSXWDEOH¿HOGRIPHGLFLQHKHLVDFFHSWHG Medical School, Çukurova University, Adana, Turkey, 2Department of History as the father of modern surgery. At-Tasrif is a thirty-volume of Medicine and Medical Ethics, Medical School, Mersin University, Mersin, Turkey, 3Department of Orthodontics, 'HQWLVWU\6FKRRO<HQL<]\ÕO8QLYHUVLW\ medical encyclopedia and its chapters on surgery contain the øVWDQEXO7XUNH\ above-mentioned drawings, while descriptions of many surgical •Corresponding author and reprints: 2\DgJHQOHU0'3K''HSDUWPHQWRI procedures are particularly important. History of Medicine and Medical Ethics, Medical School, Mersin University, th Mersin, Turkey. Tel: +90-5327813855/ +90-3243610684, E-mail: oyaogenler@ Anatolian physician and surgeon of 15 FHQWXU\ ùHUHIHGGLQ gmail.com. 6DEXQFXR÷OX>FLUFD±@ZDVDSURPLQHQWIROORZHURI$O Accepted for publication: 15 June 2016 Zahrawi. In his book titled as “Cerrahiyetü’l Haniyye (Imperial Archives of Iranian Medicine, Volume 20, Number 3, March 2017 193 &ODVVLFDO:RRGHQ9DJLQDO6SHFXOXP Figure 1.6SHFXOXPGUDZLQJIURPWKHWKFKDSWHURIWKHERRN³at Tasrif” Figure 2. &RPSXWHUDLGHG GHVLJQ PDGH E\ $NÕQ d|PHOHNR÷OX RI WKH RI=DKUDYL +XQWLQJWRQFRS\ ZRRGHQYDJLQDOVSHFXOXP Surgery)”, the explanation of medical instruments with drawings VSHFXOXPSURYLGHGE\WKHERRNVRI$O=DKUDZLDQG6DEXQFXR÷OX was used in a way similar to “At Tasrif”.7 Aside from presenting a wooden vaginal speculum was manufactured under the WKH GUDZLQJV RI PHGLFDO LQVWUXPHQWV 6DEXQFXR÷OX SURYLGHG supervision of authors of this article. Computer-aided design of miniatures depicting the practices conducted.76DEXQFXR÷OXLVWKH this tool was made pursuant to the original by mechanical engineer ¿UVW DXWKRU RI PHGLFLQH ZKR H[SODLQHG WKH PHGLFDO SURFHGXUHV $NÕQd|PHOHNR÷OXZLWKWKHJXLGDQFHRIWKHDXWKRUV )LJXUH with drawings. In this context, Cerrâhiyyet’ül-HâniyyeLVWKH¿UVW In the 77thFKDSWHURIWKHERRNRI6DEXQFXR÷OXWLWOHG³,WGHVFULEHV medical textbook depicting how the vaginal speculum is applied the shapes of the tools used to remove the baby who died in the on patients.7 mother’s womb”, vaginal speculum is one of the medical tools Due to oxidation of metal and decay of wood, most of the historical mentioned.7 The section of the chapter used as a basis for the medical instruments do not exist anymore.2,3 For this reason, to remanufacturing of this tool is given below: gain information about the forms and clinical uses of historical “Let us explain and show the usage and the shape of speculum, instruments manufactured from such materials, the best approach which is mentioned in the 74th chapter. You have to manufacture LVJHQHUDOO\WRFKRRVHWKHLQGLUHFWZD\ZKLFKLVEHQH¿WLQJIURPROG this tool from the ebony tree or boxwood tree. It should be like medical books.10 In this context, medical manuscripts containing the tool with which they cut the edges of books. But the width of instrumental drawings have a higher value.10 WKLVWRROIRUHDFKVLGHVKRXOGEHWZR¿QJHUEUHDGWKVLWVWKLFNQHVV 7KHFRQ¿JXUDWLRQRIAt-Tasrif and Cerrâhiyyet’ül-Hâniyye are VKRXOGEHRQH¿QJHUEUHDGWKDQGLWVOHQJWKVKRXOGEHRQHDQGD parallel, and their chapter numbers are same. In the 74th chapter half hand span. And its augers must be four; two of which are RI WKH ERRNV ERWK $O=DKUDZL DQG 6DEXQFXR÷OX PHQWLRQHG twisted in the same side towards the same direction and the other diseases in which vaginal speculum is used. Moreover, in this two are twisted in the opposite side towards the opposite direction. chapter we can also see the illustration of the instrument drawn Also, two pieces of board must be placed in the middle of the two E\ 6DEXQFXR÷OX7,9 In the 77th FKDSWHU IRFXVLQJ RQ GLI¿FXOW main boards with augers. Their length should be half hand span deliveries, while Al-Zahrawi’s book includes the drawing of the DQGWKHLUZLGWKVKRXOGEHWZR¿QJHUV7KHWZRSLHFHVRIERDUG LQVWUXPHQW )LJXUH 6DEXQFXR÷OX¶V LQFOXGHV D PLQLDWXUH RQ should be so compacted that they should look like just one single how to use it (Figure 2).7,9 Among its numerous original features, board. They must twist those four augers one by one until the tool Cerrâhiyyet’ül-Hâniyye is also special for being the only book gives way to open the vagina by diverging these two boards and demonstrating the use of wooden speculum. According to inserting the tool into vagina during surgery, so that the surgeon 6DEXQFXR÷OX DQG$O=DKUDZL WKH VSHFXOXP ZLWK OHDYHV PDGH would carry out the orders we state. Yet, patients must sit on a from wood does not exist anymore. U-shaped seat during surgery”. There is an important difference regarding our topic between During the designing phase based on the text and the drawing the genital examination miniatures in 77th chapters of two main mentioned above, the lengths given in terms of hand span and FRSLHVRIWKH6DEXQFXR÷OX¶VERRNZULWWHQDQGGUDZQE\WKHDXWKRU ¿QJHUEUHDGWK ZHUH FRQYHUWHG LQWR WKH PHWULF V\VWHP )RU WKLV KLPVHOI$OWKRXJK WKH PLQLDWXUH LQ øVWDQEXO Millet Kütüphanesi) FRQYHUVLRQWKHKDQGRId|PHOHNR÷OXZDVWDNHQDVDUHIHUHQFH copy contains a vaginal speculum, the one in Paris (Bibliothèque and all the measurements were applied based on his hand. Two National GRHVQRW6LQFHWKHPLQLDWXUHRIøVWDQEXOFRS\LVZRUQDQG