On curettes and curetting / by Alexander Keiller.

  • Keiller, Alexander, 1811-1892.
Date:
[1878]
Catalogue details

Licence: Public Domain Mark

Credit: On curettes and curetting / by Alexander Keiller. Source: Wellcome Collection.

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    irritation and denudation of surfaces, wliicli it is better to avoid. It may be true that, as a rule, the application of a curette is far from difficult, and that, generally speaking, little or no preparation of the part involved is necessary; but such ease of application and uncalled-for previous preparation do not always obtain, for not only do difficulties frequently occur in the introduction of the instrument, but previous dilatation of the cervical canal is required. 1 have so long and so often used the instruments I now exhibit, and which are to all intents and purposes curettes, that I think I now know the occasions on which they ought to be used, which, however, are much less frequent than I at one time held them to be. So long as our instrumental or other artificial appliances are cautiously and judiciously used for the purpose of aiding, and not forcing, nature to secure a remedy for her occasional distress, we cannot fail to do good, especially in well-selected cases ; but when we allow ourselves to be led to have frequent recourse to the rougher measures of scraping, shaving, or gouging, which the suffering uterus is too commonly subjected to, we need not be astonished if our cures are very exceptional, compared to what we may find recorded by authorities ” in whose guidance we naturally enough confide. The present observations are more applicable to the sharper, and therefore more dangerous, form of instrument than to that of the ‘Mull-wire curette” devised by Dr Thomas, and so highly extolled in the excellent communication with which Dr Munde has been good enough to favour our Society. I quite agree with Dr Munde, and with the authors he has named, as to the comparative safety and merits of an instrument not only considerably blunted and smoothly rounded, but formed of a ductile or flexible material, and not, as in the various curettes formerly used and recommended, for cutting or scooping the endometrium, made of sharp-edged and inflexible steel. In the use of such sharp-cutting curettes I have long ceased to be a practising party, and heartily concur in Dr M.’s observations to the effect that in this milder kind of uterine surgery (or what I now venture to designate the Surgery of the Endome¬ trium), it is better to abolish the use of such risky instruments as those of an inflexible nature, and presenting sharp-cutting edges, unless absolutely required for the disintegration and separation of dense and too firmly attached neoplasms and other growths found to be inseparable by the dull-wire or other comparatively flexible and safe form of curette. While I believe with Dr Munde that the “ dull-wire curette ” of Thomas is a vast improvement on the older and sharper “ subacute ” (or rather too acute) curettes of Eecamier, Sim, and others, that VOL. XXIV.—NO. IV. 2 T
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