THE USE OF TIIE CURETTE.
Although Chassaignac, and later Becquerel, Dubois, Sc anzoni and others, were opposed to the instru ment, it still remained in use. Still, only on the discovery of means for dilating the uterine cavity and the resulting possibility of recognizing the proliferating new growths of the mucous membrane, as also the fungous and polypoid forms of endometritis, did the improved Sims curette begin to be used in place of the Recamier, and did it and the Simon sharp scoop become recognized as marked additions to the gynecological armamen tarium.
Of the instruments which are used for scraping the endometrium there are, in addition to Recamier's, which A. Martin still prefers, the Sims curette; very similar instruments are used by Spiegelberg, C. Braun and others; the Simon spoon with or without Freund's modification which converts it into an irrigating apparatus.
The curette consisted originally of an oval steel ring, sharpened on one side and fixed to a flexible metal handle, whereby it was possible to give the instrument any desired curve. The more recent instruments have in general been constructed of the same material. Munde has had dull curettes constructed of copper wire, and these are, of course, softer and more flexible.
This flexibility renders the instrument best adapted for removing soft growths or remnants which have already been scraped oft Simon's scoops are oval or round, the sharpened edge projects only a trifle, and they are attached to a shaft about seven inches long, the side of which corresponding to the scraping surface is roughened. They are made in varying sizes and thicknesses.
Freund has perforated the shaft so as to allow of irrigation during the curetting.
For the removal of very soft masses the finger-nail, the handle of a scalpel, the dressing-forceps, answer very well. Farkas' curette has in deed the shape of the finger-nail. Schultze's curette forceps are very convenient for the removal of small tumors or projections. If the instru ment be constructed, as is mine, so that the blades can be disarticulated, then each blade is itself a curette. These curette forceps are constructed . with the cutting edge at the apex or at the sides.
The curette is used either from a diagnostic standpoint for the re moval of portions of tissue for microscopic diagnosis, or else for the removal of diseased tissue or masses. Following the use of the curette, which usually can scarcely be called an operation, the knife or the scissors are often resorted to for the more complete removal of growths, or else caustics are applied primarily, for, particularly in case of great infiltration, it is not possible to attack this with the curette, until the hot iron or the potential cautery has been used.
Curetting does not, however, subserve the purpose alone of removal of tissue; it also produces an irritant, traumatic effect, and cleanses the surface for the application of therapeutic agents. For this reason the procedure is resorted to in instances of chronic catarrh, where there exist polypoid and fungous vegetations, or where the mucous membrane is much thickened and altered. Often, also, the curette is called for in case of simple chronic cervical catarrh, either alone or else as a prepara tory measure to resort to caustics. Most frequently the curette is used to remove the softer, infiltrated varieties of new growths, such as adenoma, sarcoma, carcinoma. The dull curette is advocated by Mind, Alloway, Schroder, Fohling, Prochownik and others, for the removal of remnants of an ovum.
Simon in particular showed that in case of non-operable carcinoma the removal of as much as possible of the masses with the curette tended to palliate for a time the chief symptoms, discharge, pain, hemorrhage, and that further careful curetting of all the recognizable cancerous masses would often check for a relatively long period the active extension of the disease The contra-indications to the use of the curette are: The presence of acute inflammatory processes of the genitals, in particular of the pares metrium, and in a less degree chronic inflammatory processes; irritability of the uterus; softness of the uterine musculature, such as exists during the puerperium; the presence of tumors which may have perforated the uterine wall; the existence of pregnancy.