One might expect our modern spirit of innovation and disruption to turn its eye on the speculum. Surely something invented so long ago, under such dubious circumstances, could use an update. And many have tried. In the past 10 years, new designs for the speculum have continuously cropped up, only to fade away again. But while medical manufacturers continue to improve the design in little ways, there has been no real contender to displace the duck-billed model. The speculum’s history is inextricably linked to extreme racism and misogyny. But for all that, it just may be the best design we’re ever likely to have.

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In 1845, Sims opened up a private hospital for women in Montgomery, Alabama. Slave owners in the surrounding areas brought their ailing women to him, and one of the more common problems he saw was something called vesicovaginal fistulas—a condition often caused by prolonged childbirth, in which a hole forms in between the bladder or rectum and the vagina. The tear causes urine and feces to pool in the vagina, creating infections, pain, and incontinence. Fixing it required a doctor to be able to look into the vaginal canal and see the hole.

J. Marion Sims engraved by R. O'Brien

(National Library of Medicine)

Sims didn’t want to have to look at a woman’s genitals. “If there was anything I hated, it was investigating the organs of the female pelvis,” Sims wrote in the autobiography he half completed before he died. This was a time when men and women interacted in very strict, pre-determined ways. Early illustrations from medical textbooks show doctors examining women’s pelvic areas by reaching their arms up beneath the layers of skirts and feeling around, literally blindly. A doctor was specifically instructed to reassure a female patient that he was not looking at her private parts by doing one of two things: gazing off into the distance or maintaining eye contact with her the entire time.

But when a patient came to Sims with an especially painful fistula, he wrote, “this poor girl was in such a condition that I was obliged to find out what was the matter with her.” He was eager to figure out a way to surgically seal up the hole, and happy to use slave women as his test subjects.

The idea for the speculum came to Sims while treating a white patient who had been thrown from a horse. After he helped her “reposition her uterus,” he had an idea. He fetched a slave, had her lay on her back with her legs up, and inserted the bent handle of a silver gravy spoon into her vagina. That’s right, the very first modern speculum was made out of a bent gravy spoon.

This new access allowed Sims to start performing surgery on the fistulas. Eventually he came up with a method for sealing them. He performed many of his experimental procedures without the benefit of anesthesia, and some of these slave women were operated on up to 30 times. Even at the time he was working, there were concerns about the ethics of his experiments. “All kinds of whispers were beginning to circulate around town,” wrote Seal Harris in a biography published in the 1950s, “dark rumors that it was a terrible thing for Sims to be allowed to keep on using human beings as experimental animals for his unproven surgical theories.” There is still an ongoing debate over whether or not to celebrate Sims’s legacy.

Specula from 1847 (U.S. National Library of Medicine)

At the time, however, the larger question wasn’t about Sims’s ethical practices as much as it was about his device. The vaginal speculum set off a vigorous debate in the medical community. “Diseases of the vulva, vagina, and cervix might be better understood and more effectively treated if physicians could see these organs, but this greater understanding came at what many physicians considered to be too high a price,” Margarete Sandelowski, a women’s health expert, wrote in a paper on the history of the speculum. Doctors thought that opening up a woman’s body might corrupt those women and turn them into prostitutes or sex-crazed maniacs.