Pathology and treatment of diseases of women.

  • August Martin
Date:
[1912]
Catalogue details

Licence: Public Domain Mark

Credit: Pathology and treatment of diseases of women. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    51/500 page 31
    The construction of the instrument does not leave any doubt of the direction of the spoon at any time. The scraped off material from the mucous membrane is carefully collected and should be examined microscopically in all cases of diagnostic curettage. It is never possible, even for the most ex- perienced, to make a positive diagnosis macroscopically from the scrapings of the mucous membrane. It is recommended to cleanse the particles superficially from blood and then to immerse them immedi- ately in alcohol (ordinary alcohol is sufficient) and to send them to the laboratory. The cavum uteri is irrigated after the curettement (see chapter, Asepsis and Technic) to remove coagulated blood and loose remaining particles of the endometrium. [I never use intrauterine irrigation, but firmly pack the uterine cavity with loose gauze. Applying a forceps to the latter I turn the gauze within the uterus with a corkscrewlike motion and thus succeed in detaching all the loose particles eventually yet remaining adherent to the uterine walls. This procedure is repeated until the gauze is returned free from any debris. Cauterization of the mucosa then follows.—Ed.] It is useful in many cases, especially where one has to deal with a chronic hypertrophic endometritis, to follow the curettement with cau- terization of the uterine wound surface. The idea is to scorch the remaining parts of the mucous membrane and thus to cause their expulsion later on, and further to secure more complete hemostasis. The number of remedies recommended for this purpose is extraordinarily large, so that their selection can be left more or less to the individual operator, as one can obtain the same result in an equally perfect manner with any of these substances. For a long time we have used undiluted liquor ferri perchloridi. Other, equally recommended remedies are: pure tincture of iodin, pure carbolic acid, 50 per cent, solution of zinc chlorid, formalin pure, or in 50 per cent, or 30 per cent, solution (Menge) and many others. Many modifications exist also in the manner and mode of application. For a long time we have employed the following method: We inject 1 ccm liquor ferri perchloridi with a Braun syringe (see Fig. 24) into the cavum uteri, in such a way that the syringe is slowly withdrawn while the plunger is pushed on quite gradually; thus the contents come forth drop by drop and moisten the walls of the uterus. Very strong pressure must be avoided in this procedure, as otherwise the escharotic enters the tubes, and immediately cauterizes the mucous membrane. It is undis- puted, that the escharotic is distributed best in the uterine cavity with the Braun syringe (Menge6). We have no occasion, after our large experience, to dispense with the careful use of Braun''s syringe. How- ever, the possibility of the caustic entering the tube leads many gynecol- ogists to reject the use of it. These prefer to soak a sound-shaped appli- cator, wrapped with cotton at one end, in the escharotic and to wipe out
    digitised image 1
    digitised image 2
    digitised image 3