We cannot sufficiently urge practice of curetting on the cadaver or an extirpated uterus, and thus we may ascertain how difficult it is to curette the entire endometrium, and also how likely it is for a portion to be left.
After the curetting has been completed the masses may be removed by the dull curette, and the cavity should then be irrigated.
At the outset hemorrhage is frequently profuse, but when normal uterine tissue is reached it generally ceases. In case, however, as in carcinoma, it has not been possible to remove all the growth, then it may be necessary to check the hemorrhage by injection of liquor ferri, or by the tamponade of the cavity.
When cauterization is indicated this should follow at once on the curetting. In case of chronic catarrh the use of caustics is rarely indi cated; indeed, for reasons already dwelt upon, it may be harmful.
In case there is no hemorrhage the tamponade is not requisite. I am in the habit, after drying the cavity, of inserting an iodoform pencil which is held in place by a gently applied iodoform gauze tampon. To favor drainage and to disinfect frequent vaginal douches should be ad ministered.
Only when the curetting is undertaken for diagnostic purposes should it be performed in office practice, very exceptionally at the best. It is ordinarily advisable to keep the patient in bed for six to eight days, although even later. as Prochownik has shown, there may result para metritis or infection, and therefore extra precautions are advisable.
Ordinarily curetting should be performed under anesthesia. In regard to the painfulness of the procedure opinions vary. I have found curetting of the uterus ordinarily very painful. Anesthesia carries with it the advantage that the operator can take his time and can satisfy him self that the procedure has been thoroughly completed.
(pessi, vaginal and uterine supports, etc.), were often in serted into the genitals by the earlier gynecologists for the purpose of correcting displacements of the uterus, in particular prolapse, and also, much more frequently, to bring medicinal agents, of which the pessaries were constructed or impregnated, into contact with the mucous mem brane of the vagina and of the cervix. Reference to these points will be found in the writings of Busch, Franque, Simpson and others.
For mechanical purposes, sponges, rolls of linen, nuts, animal blad ders (Albucasis) were inserted into the vagina, but the first reference to the instruments we use to-day dates from the time of Ambroise Pare (1573). Since then an incredible number of pessaries have been devised, the greater number of which are purely of historical interest.
It was not till 1820, when changes in the position of the uterus were clearly recognized, that vaginal pessaries were scientifically used, and that Amussat began to treat uterine flexions by the stem, the special orthopedic method applicable to distortions of the uterus, which has excited so much discussion, and is still to-day matter of controversy, the question in dis pute being as to whether the symptoms are to be traced to flexion and to version or else to affections complicating them. We do not propose here, however, to discuss the special topic of treatment of uterine displace ments, but we are concerned largely with the general rules applicable to pessaries and with the technique of their insertion.