Sixty-five eases of endornetritis fun gosa treated by curetting; 92.2 per cent. completely cured; 13.8 per cent. much improved. Should be performed with patients in Sims's position. Hans Vogel bach (Inaugural Dissertation, '94).
The most thoroligh results are ob tained when both the curette and the sharp spoon are used, especially the smallest-sized instruments, which can be inserted into- the corium of the uterus and between the rugie. Where there is marked glandular hyperplasia, early re currence is apt to follow the most vig orous scraping unless the raw surface is thoroughly cauterized at once. R. Werth (Archly f. Gynak., B. 49, H. 3, '95).
In 297 cases treatment consisted of dilatation and curettage of the uterine cavity, followed by thorough application to the endometrium of 50-per-cent. solu tion of chloride of zine in the worst cases, and of a solution of iodized phenol in milder cases. A sterilized drain was then inserted through the internal os, the patient put to bed, and all precau tions taken against inflammatory reac tion. A repetition of the cauterization with milder solution, if thought best, usually resulted in a permanent cure in the course of two or three weeks. There were 197 cures and 94 cases of improve ment out of 297 operations, only 6 being mentioned as discharged unimproved. The best hope for a permanent cure of chronic endometritis would result from impregnation and normal delivery. Paul F. Muncie ("Report of Gymecological Service at Mount Sinai Hospital," '95).
In acute catarrhal endometritis elec tricity is an effective remedy, faradiza tion and the negative pole of the gal vanic current fulfilling the requirements of local treatment. ln chronic catarrhal endometritis the positive pole of the gal Vallie current and zinc electrolysis, com bined with faradization, are also effect ive. Acute septic or specific endome tritis demands gentle dilatation and thorough irrigation with antiseptic solu tions. In chronic endometritis resulting from septic or specific infection, cu rettage, gauze drainage, and subse quently irrigation. Senile endometritis ean best be overcome by dilatation and drainage bronght about by means of the negative pole of the galvanic cuiTent, and, when necessary, irrigation of the cavity with a saturated solution of boric acid or Thiersch's solution. A. H. Goelet
(Ainer. Jour. of Obstet., Sept., '95).
Curettage has proved disappointing; if the infection of the mucous membrane is recent, curetting is very liable to open up new channels of infection, carrying the inflammation to deeper parts; if, on the contrary, the infection is an old one, the deepest portions of the endometrium have probably become affected, and those layers curettage could not remove without destroying the entire mem brane. ln eases of septic and of acute puerperal infection, curettage is, there fore, useful only for the purpose of removing foreign material, retained and adherent debris, etc. II. T. Byford (Wisconsin AIM. Recorder, iii, No. 11, 1900).
When the curette is employed due care should be exercised. Rough manipula tion and undue pressure upon the uter ine surfaces have been followed by un toward results. Curettage should be avoided when there is tenderness in the tissues beside the uterus.
Temporary uterine paralysis occasion ally occurs during the operation of cu retting under chloroform narcosis, which might lead one to think that Ile had perforated the uterine wall and was mov ing the curette freely in the peritoneal cavity, were it not for the absence of shock, a.s manifested by the normal pulse, respiration, and appearance of the pa tient. ( 4,y1 (Arch. f. II. 3, '88).
Four cases noted where death has oc curred from septic peritonitis after cu retting. Reeves Jackson (Annals of Gynee., Apr., 'SS).
Case of death reported resulting from au intra-uterine injection of perchloride of iron, The patient was curetted for endometritis, and, owing to the bleeding, the following day iron was, carefully in jected drop by drop. She died two hours later. At the post-mortem clots were found in the uterus and thrombi in the iliac veins. Pletzer (Provincial Med. Jour., Aug., '92).