The dull wire curette in gynecological practice / by Paul F. Mundé.

  • Mundé, Paul F. (Paul Fortunatus), 1846-1902.
Date:
[1878]
Catalogue details

Licence: Public Domain Mark

Credit: The dull wire curette in gynecological practice / by Paul F. Mundé. Source: Wellcome Collection.

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    complete and valuable paper above mentioned, or to the original in the Archiv fur Gyndkologie, vol. viii., No. 1, entitled “Chronische Hyperplastische Endometritis.” It is, so far as I am aware, the only contribution to medical literature specially devoted to that subject. Description of the Instrument.—Thomas’s “ copper-wire curette without cutting edge ” (as he himself calls it) is an instrument 9 inches long, 3J inches of which form the wooden handle, made of soft copper wire inch thick near the handle, and tapering down to t1 2 to tV inch in thickness at ^ inch from the end, where it is bent into an elliptical loop J inch broad, the wire at the loop being flattened on the scraping surface. The wire at the inception of the loop is so soft and flexible, that any greater than a superficial pres¬ sure will cause it to bend, whereby a deep injury to the uterine mucosa is absolutely avoided. Besides, at the junction of wire and handle, the former is grooved, so as to bend easily at the point, also with the object of preventing firm pressure. The breadth of the loop mentioned above, J inch, is the usual size ; but there are two other sizes made, one larger and one smaller, in proportion to the patency of the cervical canal. It may seem that this flexible blunt loop of wire is too frail to be of real service, but experience has amply shown that it fully answers the purpose for which it was intended, and that gently drawing it over the uterine mucous membrane suffices to detach the projecting vegetations or granulations and to cure the case, without requiring or subjecting the patient to the danger accompanying the use of a stiff sharp steel scoop. Indications.—There is really only one indication for the use of the curette, and that is pathological uterine haemorrhage; menor¬ rhagia, or metrorrhagia, which has resisted all other remedies, and for which no physical cause, constitutional or local, can be detected by the usual means of exploration. In such a case we are com¬ pelled to look for the cause of the haemorrhage in some intrauterine disease, not distinguishable by the ordinary digital and specular examination. The curette will then give us the required informa¬ tion, for by it we shall either remove a portion of the fons et origo mali, or receive a negative result at least, in the assurance that the uterine cavity is empty and healthy. The first and chief use of the curette, therefore, is as a means of diagnosis, and as such it must be employed in almost every case until its withdrawal shows the pre¬ sence or absence of an exciting cause.1 The unirritating nature of 1 Although I have repeatedly heard Dr Thomas mention this diagnostic use of the curette, in no text-book or paper do I find it recorded except in that of Hegar and Kaltenbacli (l.c.), who make precisely the same use of Sims’s curette (or Recamier’s, as they call it). With Sims’s instrument, however, the opera¬ tion can evidently he neither so gentle nor so innocuous as with the wire curette, which latter answers every purpose.