The greatest danger of the curette does not lie in perforating the walls oi the uterus, but in salpingitis, the ex citation of peristaltic movements, and the forcing of material into the peri toneum. The worst procedure that can be imagined in this connection is to fol low curetting by injection. Landau pled. I'ress and Circ., Dec. 5, '94).
Case in which perforation with curette ended in death. Itatray (These de Paris, '93).
[Uterus punctured in a number of eases and in none of them have any ab normal symptoms resulted. E. E.31.Ioxi. GOMERY, Assoc. Ed., Annual, '961 Regeneration of endometrium after curetting varies widely, according to manner in which operation performed. Where there is marked glandular hyper plasia, early recurrence apt to follow most vigorous scraping unless raw sur face cauterized at once. When liquor ferri applied after curetting, regenera tion of epithelium delayed. R. Werth (Archiv f. Gyniik., B. 49, II. 3, '95).
Fifteen days a minimum limit for the uterine mucosa to reproduce itself so as to be physiologically active after cu retting. Bossi (Gaz. degli Osp., Feb. 2, '93).
Exfoliative endometritis and polypoid endometritis may require more than one curettage.
In a large proportion of cases the cer vical canal is small or bent, and must be kept diluted for several weeks subse quently to promote uterine drainage.
Introduction of a gauze pad or drain into the non-puerperal uterus for the purpose only of drainage is unnecessary and possibly open to objection. While the presence of a pad of gauze in a flabby, septic uterus after curetting may produce contraction of that organ, still it acts as an obstacle to the escape of septic discharges. II. C. Coe (Amer. Gymec. and Obstet. Jour.. June, '95).
Iodoform-ganze packing does not drain at all. IL J. Boldt (Amer. Jour. of Obstet., Sept., '95).
Teri» "packing" a misnomer. Tig,ht packing only indicated in certain condi tions to stimulate contraction of uterus. Goelet (Amer. Jour. of Obstet., Sept., '95).
In others it is necessary to use strong astringents and antiseptics to the endo metrium, to counteract the tendency to a recurrence of the hyperplasia or the sepsis.
The hot vaginal douche twice daily acts beneficially as a sedative to the pel vic circulation, and aids in keeping the vagina clean.
Local treatment may be commenced in two or three weeks after the operation. If the cervix is small or bent, a round dilator, or male urethral sound -No. 12 to No. 15, should be passed through the internal os once or twice a. week. In order to avoid infection, the patient should take a large hot vaginal douche shortly before the treatment, and the gynmcologist should wipe out and dis infect the vaginal fornices and cervix through the speculum before intro ducing the disinfected sound.
After the sound is withdrawn a 50-per cent. solution of ichthyol in glycerin may be applied to the endometrium, or, if the case has been an luemorrhagic one, pure lysol or carbolic acid, or a 20-per cent. solution of chloride of zinc, every ten days to two weeks.
Action of the sulphate of copper is a superficial one, not producing the deep esehar made by chloride of zinc, and it is just as effective as zinc, and does not produce atresia of the cervix. Cases cured by the copper treatment in from four to twenty-five days. Only one ap plication was made. As a preliminary step, strict antisepsis of the genital tract I recommended, rest in bed, giving bro- I 'nide one day previous, repeating it, and, if necessary, a uterine injection of chlo ral. Arnaud (Bull. Gen. de Ther., May 15, '92).
Carbolic acid most efficient and safest application. Does not burn deeply enough to destroy submucous tissue. Not good practice to make traction upon organ and pack it every other day. A. P. Dudley (Amer. Jour. Obstet., Sept., '95).
Treatment by chloride of zinc given up because of the tendency of this agent to produce eicatrization of the surface. A. Jacobi (Med. Record, Oct. 19, '95).
More general use of nitrate of silver advocated in the treatment of endometri tis. The application of the nitrate of silver should be made carefully and thoroughly, and to do this it is abso lutely necessary that all unhealthy se cretions should be removed previously from the interior of the uterus, and the latter be left clean and dry. For mild cases and those seen early 5- or 10-grain solution of nitrate of silver used, but the more chronic cases require much stronger solutions or even a light touch ing with the solid stick. William H. Robb (.N. Y. Med. Jour., Dec. 5, '96).