US2858826A - Vaginal speculum - Google Patents

Description

Nov. 4, 1958 E. KAHN VAGINAL SPECULUM 5 Sheets-Sheet 1 Filed Jan. 22, 1957 INVENTOR. EDWARD KAHN.

ATTORNEY Nov. 4, 1958 E. KAHN 2,858,826

VAGINAL SPECULUM 3 Sheets-Sheet 2 Filed Jan. 22, 1957 INVENTOR. EDWARD KAHN Aime/vex Nov. 4, 1958 E. KAHN VAGINAL SPECULUM Filed Jan. 22, 1957 3 Sheets-Sheet 3 INVENTOR. 0 WARD KAHN.

ATTORNEY United States VAGINAL SPECULUM' Edward Kahu, Queens Village, N. Application January 22,1957, Serial No..635,316

'Claims. (Cl. 128-17) This invention relates to surgical instruments and, more-;partieularly, to a metal vaginal, speculum having meanspermitting a side openingwhen required.

The-imetalv Gravesvaginal speculum has been-found quite-satisfactoryfor-various routine examinations and treatments of the'vaginal-canal and cervix uteri, and is acknowledgedto be-the most popular type of speculum usedforltheqpurpose. The Graves'speculum has many advantages. amongst'which'are its simplicity of operation; the-good exposure obtained by its use; the fact that ithasa stemor -handle .whichipermits handling of the instrument without contaminating the sterilized blades thatenter, the vagina, the handle or stem also facilitating maneuvering the :instrument into position for improved exposure of the .cervix; and the fact that, by a simple reversal-ofzihe blades bythe' use of its stem'and set screw it converts-'toa Sims speculum which has its own special uses :for exposing the cervix in the Sims or kneechest 1 positions:

The Graves speculum, however, has certain shortcomingsfonspecial diagnostic and treatment procedures that have-been" developed since the Graves speculum was originally. designed, and so the present invention has beenzdevised to:bring the Graves speculum up to date withouthaving *10 modify the classic simplicity of design orioperation'that has made it so popular for general use.

The special procedures for which the improvements have beeir'devised are: hystero-salpingography (uteroisalpingography), hysterogr-aphy (uterography), and :cervicography, for the investigation and treatment of female infertility due to non-patency ofthe fallopian tubes,;.;defects ,in' development, or other pathological conditions ;(salpingography), and for the investigation and; treatment of defects in development, or other pathologicalvconditions ofthe uterine cavity (hysterography), and--ofthe cervical canal (cervicography) An; objectzofthis invention,*therefore, is to ,provide a metal speculum-that is-simple in construction, and provided-with a mobile supporting arm removably locked iniiplacento perfornrfunctionally as does the fixed supportingaarm on the left side of the conventional Graves speculum, but capable of beingunlatched when required to {provide a temporary open side for special procedures, wherein the: speculum is readily removed from the vaginalreanahwithout disturbing other instruments positioned therewith, and which will overcome the aforementioned'soperat-ional difficulfies.

' Another object of; this invention is to provide a Graves typeof speculum, having a pair of relatively movable" bladespivotally connected and in which the pivot at one side thereof may be disconnected to permit the' withdrawal of the speculum longitudinally and transversely relative to adjacent. instruments positioned within the vaginal canal.

'Still another object of the present inventionis to provide a Graves type speculum having a sidezopening and removable joint connection for removing and introduc- Patented Nov. 4, 1958 z ing the speculum-in the vaginal.canalindependentlytof other instruments positioned IhtiIWi'thiIl.

A still further object of this inventionis to provide a side. opening Graves type of speculum that. maybe readily converted to a Sims type of speculum;

All of the. foregoing, as well as additional objects and advantages of this invention will'become apparent from a study of the following specification,.taken in connection with the accompanying drawing, wherein:

Fig. 1 is a diagrammatic'view showing a speculum partly in section, and made in accordance with the present invention, in operative 'associationwithin the vaginal canal, togetherwith a tenaculumand'cannula.

Fig. 2 is a view similar to Fig. l, with thelspeculum removed from the vaginal canaL -and the cervix under traction by the tenaculum.

Fig; 3 is a top plan view of the, apparatus shown=in Fig. 2.

Fig. 4 is a rearelevational view of 'one'form of speculum madein accordance with the present invention.

Fig. 4a is an-enlarged fragmentary view showing the pivot bearing :latch construction of the speculum shown in Fig. 4.

Fig. 4b is a view similar to Fig. 4a but showing a modification of the latch.' I

Fig. 5 is a side elevational view of thespeculum shown in:Fig. '4.

Fig. 6 is a view similar to Fig. 5, showing the opposite side of the speculum.-

Fig. 6a is a side'elevational-viewof thespeculum shown in Figs. 4 to 6 converted from a Graves type to a Sims type ofspeculum:

Fig. 7 is a frontelevational view of the speculum shown in Fig. 6.

Fig. 8 is a view similar to Fig. 4, showing the speculum in an-open position in the'hand of anioperator.

Fig. 9 is a view similar to Fig. 9 with the speculum in a side-open position.

Fig. 9a'is an enlarged fragmentary view similar to Fig. 4a showing the other pivotal connectionof the speculum.

Fig. 10 is a view similar to Fig.5, showing a modified form of the present invention.

Fig. 11 is a rear elevational view of the deviceshown in Fig. 10.

Fig. 12 is a view similar to Fig, 10, showing the device in a side-open position.

Fig. 13 is an enlarged. fragmentary view of the device shown in Fig. 10, showing a pivotal connection thereof.

Fig. 14 isa view similar to Fig. l3, showingthe parts in an open position.

Fig. 15 is a side'elevational view of the still further modified form of the present invention- Fig. 16 is a rear elevational view of-the speculum shown in Fig.15.'

Fig. 17 is a view similar to Fig-16, showing theparts in an open position.

Referring now to Figs. 1 to 3 of the drawing, a speculum 20 'made in accordance with the.=present invention is shown in operative association with the vaginal canal 22 of a female human body. As is more clearly discussed in my Patent No. 2,482,622, dated September 20, 1949, the speculum 20 isv used in connection with a tenaculum 24 to provide access to the cervix by the cannula 25. Both the tenaculum and cannula extend through the housing or opening definedby the speculum and are supported on an adjustable base 27 that is secured to the examination table 28. The-teeth 30*of the tenaculum are arrangedto grip theanterior lip -31 of the cervix 32 and drawit, towards theopening of the vaginal canal, as more clearly shown-in Fig. 2. Ins this position, the cannula 25 is properly positioned within. the straightened cervico uterine canal for the X-ray visualization of the adjacent areas. Because of the novel construction of the speculum of the present invention, the speculum is capable of being removed from the cervix, without disturbing the position of the tenaculum and cannula that are supported on the adjustable'base.

Referring now to Figs. 4 to 9 of the drawing, one form of the present invention is shown to include a speculum 20 having a lower blade assembly 36 and an upper blade assembly 37. The lower blade assembly 36 is of an inverted L-shaped configuration and includes a lower blade 39 and a perpendicularly related integral leg 40. The

upper blade assembly-37 includes a Y-shaped yoke 43 and an upper blade 42 pivotally supported thereon, for a jaw-like movement relative to the lower blade 39. The rearward upper edge of the upper blade 42 is provided with an open slot 44 to permit the manipulation of instruments inserted through the speculum. As is more clearly shown in Fig. 4, the base of the yoke 43 is provided with an elongated vertical slot 45 through which extends the threaded portion 46 of a stud 47 which is secured to the leg 40 of the lower blade assembly. A thumb screw 48 threadingly engaged with the stud 47 is adapted to be rotated into securing engagement with the yoke 43 to maintain it in a desired vertical position relative to the lower blade assembly 36. A serrated thumb plate 50 at the base of the yoke 43, together with a finger bar flange 51 at the bottom of the leg 40, provides an expedient means for adjusting the relative vertical position of the upper and the lower blade assemblies which may be maintained by the thumb screw 48.

The yoke 43 includes a pair of upwardly extending cars 53, 54, which are arranged tosupport the upper blade 42 through a pair of similar downwardly extending ears 57, 58. A pivot pin 59 secured to the downwardly extending ear 58, as shown in Fig. 9a, extends through an enlarged opening 60 in the upwardly extending ear 54 of the yoke, and is secured therein by means of the enlarged head 61 thereof. The enlarged opening 60 in the ear provides somewhat of a universal joint connection for the upper plate 42 so that it may be rotated to substantially any angle relative thereto, as more clearly shown in Fig. 8. The other downwardly extending ear 57 of the upper blade is provided with a rigid pivot pin 63 that is arranged to be received within an opening 64 (Fig. 9) in the rotatable trunnion latch plate 65 that is pivotally supported on the upwardly extending ear 53 of the yoke by means of a pivot pin 67. This plate has a perpendicularly extending forward lug 69 and a somewhat smaller rearward lug 70 that are arranged to receive the upwardly extending ear 53 of the yoke therebetween when placed in a vertical position. A flanged finger plate 71 that flares outwardly from the latch plate 65 provides a means for rotating the trunnion plate into and out of the vertical ear engaging position shown in Fig. 5, wherein the pivot pin 63 is rotatably secured within the opening 64 of the plate. Movement out of the vertical position is resisted by the forward lug 69 and a coil spring 73 which encircles the pivot pin 67 and acts between the plate 65 and the enlarged head 74 of the pin.

The opposite side of the upper blade 42 is provided with a downwardly extending serrated thumb plate 76 that has a vertically elongated slot 77 (Fig. 7) intermediate its length. This slot is arranged to receive a threaded stud 79 having an enlarged opening 80 at one end 81 thereof for rotatably receiving a pin 82 fixed to the side of the upwardly extending ear 54 of the yoke 43. The threaded end of the stud 79 extends through the enlarged opening 80 in the thumb plate and is threadingly engaged with a thumb screw 83 which abuts the thumb plate so as to maintain it in a selective open position. The side of the thumb plate 76 is provided with a depression 85 which may be engaged by a thumb to urge the upper blade about a longitudinal axis of the speculum to an inclined position when the opposite side 4 of the blade is moved out of its rotatable engagement with the trunnion plate 65.

In using the speculum, the trunnion plate 65 is swung into securing engagement with the pivot pin 63 and the adjustable thumb screw 83 threaded outwardly to permit the complete closing of the upper blade 42 relative to the lower blade 39, and the yoke 43 lowered relative to the lower blade assembly to its lowermost position. The speculum is then inserted into the vaginal canal and the upper and lower blade assemblies moved vertically apart sufiiciently to expose as much of the cervix as possible, the blade assembly being held in the desired position by means of the thumb screw 48. By exerting a pressure on the thumb plate 76 the upper blade 42 is rotated upwardly relative to the lower blade 39 more completely to expose the cervix and upper vagina, the desired position thereof being maintained by the set screw 83 which may be rotated into abutment with the upper portion of the thumb plate. The instruments necessary for the gynecological procedures are then inserted into the vaginal canal through the opening or housing defined between the upper and lower blades of the speculum, as more clearly shown in Figs. 1, 2, and 3. With these instruments in proper position, it is necessary to withdraw the speculum to permit X-ray visualization of the studied parts. This is done by urging the trunnion latch plate 65 out of its normally vertical position in engagement with the upwardly extending ear of the yoke 43 to a released position 65a by exerting an outward pressure on the finger plate 71 to urge it to its extended position 71a as shown in Fig. 4a. This movement releases the pivot pin 63 from engagement with the opening 64 in the trunnion plate 65 so that the instruments 24, 25, which are maintained within the vaginal canal, may pass through the opening provided by the removal of the pivotal connection. In withdrawing the speculum, a pressure is exerted in the depression of the thumb plate 76 so as to rotate the upper blade 42 of the speculum to the position shown in Fig. 8 so that the other instruments are not disturbed. The thumb screw 48 may also be loosened so as to permit the upper and lower blade assemblies 36, 37, to be closed vertically together to facilitate the withdrawal of the speculum. Should it be desired to reinsert the speculum in the presence of the other instruments, the steps outlined above may merely be reversed and the speculum returned to the initial position.

It will be recognized that the speculum is provided with a pivotal connection at each side of the upper and lower blade as in the conventional Graves type speculum so that the leverage available is the same as with the conventional Graves speculum, giving two fixed pivot points for the upper blade of the speculum so that resistance of the vaginal canal is readily overcome with minimum manipulation. Also, one of the pivots may be disengaged or unlatched so as to permit the withdrawal of the speculum without disturbing other positioned instruments within the vaginal canal. If desired, the upper and lower blade assemblies 36, 37, may be reversed, as shown in Fig. 6a so as to provide a Sims type speculum for use in a conventional manner, thih removable pivot construction not interfering there- W1 In the modification shown in Fig. 4b, it will be seen that the latch plate 65a is bowed outwardly as at 65b to fit over and slidingly engage pin 67a and terminates in a finger piece 650 which, when pressed by an operators thumb, will remove the latch plate 65a from engagement with the pivot pin 63 in the upper blade 42, the coil spring 73a serving to bias the latch plate into engagement with the pivot pin 63.

Referring now to Figs. 10 to 14, a modified form of the present invention is shown wherein the parts are identical with those hereinbefore described except for 'the arrangement of the removable pivot assembly at .5 one side of the speculum; As, hereinbefore explained, one side of the upper blade 42 is pivotallysecured to an upwardly .e teud ngr r 542 f t ey ke y ns of a flost motion type of pivot pin 59 (see .Fig. .9a) which gives substantial universal movement of the; blade relative to thelower blade 39: The opposite side of the upper blade 42 is provided with a fixed pivot pin 101 to which a rotatable trunnion link 100 is secured. The free end of the trunnion link 100 is provided with a rotatable thumb screw 103 which is arranged to engage with a threaded bore 105 in the side of the upwardly extending car 53 of the yoke, as more clearly shown in Fig. 14. In using this form of speculum, the pivotal connection between'the upper and lower blades may be broken merely by threadingly disengaging the thumb screw 103 from engagement with the bore 105 in the yoke, so as to permit rotation of the latch link to an inoperative position 100a, as shown in Figs. 12 and 14,

in which position the speculum may be rotated, if necessary, to clear any instruments extending through the speculum as it is withdrawn from the vagina.

Referring now to Figs. 15 to 17, a still further modified form of the present invention is shown which is substantially identical to those hereinbefore described, except for a still further modified arrangement of the removable pivot link assembly. As more clearly shown in Fig. 17, a fixed pivot 201 rotatably supports the lever 200 from one side of the upper blade 42. This lever 200 is provided with a broadened portion 203 at its free end which has an outwardly opening U-shaped slot 205 that is arranged to receive a stud 206 rotatably supported in a U-shaped bracket 208 that is secured to the side of the yoke 43. In a closed operative position of the speculum, the link 200 is in a lowered position so that the broadened portion 203 is disposed between the bracket 208 and the shoulder 210 of a thumb screw 211 that is threadingly engaged with the stud 206. The thumb screw permits the securement or release of the link therein. In moving the link 203 from a closed position, as shown in Fig. 16, to an open position 200a, as shown in Fig. 17, the speculum may be withdrawn from the vaginal canal without interfering with the other instruments 24, 25, in a manner similar to that hereinbefore explained.

In all the foregoing embodiments of the present invention, the upper and lower blade assemblies may be reversed so as to adapt the speculum for use as a Sims speculum of the type shown in Fig. 6a. Accordingly, this speculum provides the operator with a practical Graves type of speculum for routine use with the added advantage of special usage in modern procedures in sterility studies and treatment and X-ray diagnosis of cervical, uterine, and tubal abnormalities, and aid in their treatment. Therefore, while the present invention has been described with particular reference to the specific forms shown in the drawing, it is to be understood that such is not to be construed as imparting limitations upon the invention, which is best defined by the claims appended hereto.

Having thus described my invention, what I claim as new and desire to secure by Letters Patent is:

1. A speculum comprising, in combination, an upper blade assembly and a lower blade assembly defining a longitudinal housing therebetween, one said blade assembly having a pivotal mounting at one end for rotation relative to the other said assembly to effect jawlike movement therebetween, said mounting comprising a pair of transversely spaced pivots, one of said pivots comprising a fixed universal joint, and the other of said pivots being selectively displaceable to provide access to the interior of said housing transversely throughout the entire length thereof.

2. A speculum, comprising, in combination, a pair of upper and lower blades defining a longitudinal housing therebetween and having a pivotal connection at one versely spaced pivotal connections end for relative rotation thereofabout. a transverse axis, saidjpivotal connection comprising a pair oftransverselyspaced pivot structures, one of saidpivot structures being'fixed and the other being selectively removable to provide access to the interior of said housing transversely of the speculum throughout the entire length thereof, said fixed pivot structure comprising a direct pivotal connection between said upper and said lower blades, and said selectively removable pivot structure comprising a lever connected at one end to one of said blades and having means at an opposite end for removable securing engagement with the other of said blades.

3. A speculum as set forth in claim 2, wherein one of said blades includes an outwardly extending pressure plate for rotating said one blade relative to said other blade, and adjustment means acting between said pressure plate and said other blade for selectively limiting the extent of movement'of said blades toward a closed position.

4. A speculum comprising, in combination, a pair of upper and lower blade assemblies defining a longitudinal housing therebetween and being pivotally connected at one end for limited relative rotation therebetween about a transverse axis, said one end including a pair of transbetween said blade assemblies, one of said connections comprising a stationary and substantially universal joint between said blade assemblies, the other of said connections comprising a selectively displaceable joint between said blade assemblies to permit access to the interior of said housing transversely of the speculum throughout the entire length thereof, and adjustment means acting between said blade assemblies for selectively limiting the pivotal movement of said blade assemblies toward a closed position.

5. A speculum as set forth in claim 4, wherein one of said blade assemblies includes an outwardly extending pressure plate for rotating one of said blade assemblies relative to the other of said blade assemblies about said transverse axis when both of said transversely spaced pivotal connections between said blade assemblies are in operative position, and for rotating one of said blade assemblies relative to the other of said blade assemblies about a longitudinal axis when said selectively displaceable joint between said blade assemblies is in an inoperative position.

6. A speculum as set forth in claim 4, wherein said selectively displaceable joint between said blade assemblies comprises a lever pivotally engaged at one end to one of said blade assemblies and rigidly but removably engaged at the other end to the other of said blade assemblies.

means engageable with mating pivot means on the other of said blade assemblies when said lever is in said fixed operative position.

8. A speculum as set forth in claim 7, wherein said lever includes spring biased positioning means for retaining said lever in both of said operative and inoperative positions.

9. A speculum as set forth in claim 4, wherein said selectively displaceable joint between said blade assemblies comprises a lever pivotally engaged at one end to one of said blade assemblies, and lock means carried at the other end of said lever for selective engagement with the other of said blade assemblies to secure said lever in fixed position relative thereto.

10. A speculum as set forth in claim 4, wherein said selective displaceable joint between said blade assemblies 2,858,826 7 r 7 comprises a lever pivotally engaged at one end to one References Cited in the file of this patent of said blade assemblies and lock means carried by the other said blade assembly for selective engagement with UNITED STATES PATENTS the other end of said lever to secure said lever in a fixed 679,712 Venning July 30, 1901 2,320,709 Arnesen June 1, 1943 position relative to said other of said blade assemblies. 5

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