Cite Itlay Curetteand Applicator

By

A. FRANK BAUER, PH. G., M. D.Chicago, 111,

Professor of Ora! Surgery North Western Dental College;Ex-Senior Resident Physician Cincinnati Hospital;

Member of the Cincinnati Medical Society,The Chicago Medical Society; and

attache of the ChicagoHealth Department.

The May Curette and ApplicatorA. FRANK BAUER, PH. Q., M. D.

Professor of Oral Surgery North Western Dental College; Ex-senior Resi-dent Physician Cincinnati Hospital; Member of the Cincinnati

Medical Society, The Chicago Medical Society; andattache of the Chicago Health Department.

The rapid and progressive stride in the Science ofGynecology has naturally led to a demand for advancedmethods and new and improved armamentaria.

Especially is this observable in the introduction ofmechanical appliances in literal trouble—as where it isdesirable to expedite inevitable abortion, miscarriage,and premature delivery and remove their retentions; orwhere difficulty is found in delivering the placenta,through persistant adherence, hour-glass contraction,abnormal enlargement, clotted invertence, succenturiaeor other anomalies of form; and again in cases of postpartum hemmorrhage, puerperal septicaemia and the re-moval of mole pregnancies. The use of the hand, evenwhen practicable, has long been condemned as primitive,barbarous and inhuman, obsolete and unworthy of aplace in the chirurgical method of the modern practi-tioner.

It is, comparatively speaking, but a few years agothat there came to the relief of the obstetrician an in-strument of incalculable value called the Curette, whichfor the future was to find a place in his bag as import-ant as that of his forceps.

It is intensely interesting to watch the evolution ofthis ingenious device from the crude spoon-shaped toolof the last decade with which a man blindly groped inin the womb, scraping in spots here and there, hittingor missing the obnoxious retentions as accident willed it,with the instrument of to-day, which explores every inch

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of the walls of the uterus and deftly removes the unde-sirable debris without inordinate pain to the patient oranxiety to the operator.

The primitive spoon-curette, the pioneer of thecurette system, though better than nothing, was literallya dangerous weapon in the hands of the operator, as hewas liable, even when exercising the greatest care, toinjure the walls of the uterus and open avenues ofinfection.

Then came others of more approved designs, infin-itely in advance of the original instrument, but stilllacking important elements, which negatived their use-fulness.

There was not one that was not open to criticism forsome aggressive fault or important deficiency. Thebest fell far short of perfection.

For a time I looked in vain for the ideal curette. 1sought for one that would get behind the retentions anddrive, not drag them out; that would purge the uterusof.its refuse without injury to its walls, that was fash-ioned with intelligent consideration of the elastic, cling-ing character of the wall of the uterus; that would actuniformly, and not scrape in spots; and, above every-thing one that offered facilities for the application ofmedicinal agents and antiseptics at the moment of oper-ation—not before, nor after—but right on the instant ofaction.

At last, when least expectant, a new curette has beenfashioned which seems to me a rational and useful in-strument, constructed on accurate and scientific lines; Ihave given it a thorough test, and results of my ex-perience in using it, make me an enthusiastic advocateof it. The instrument to which I refer is the MayCurette and Applicator,

It consists of a single shaft of metal, ten inches long,terminating at one end in a spiral formation, and at theother in a flat shaped handle. The spiral formationdescribes two circles, and is so arranged as to make onecomplete central circle and one half at either extremityproducing an olive-shaped curetting surface.

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FIG. 2.

FIG.I.

FIG.3.

Fig. 1. The spirally formed por-tion of the instrument.

Pig. 2. The instrument entire withgauze attachment. The curvature at

apex points upward and is the posi-tion in which it should be held, soas to conform to the normal uterineaxis.

Fig. 3. An enlarged detail section of thefree border of the instrument, showingthe groove for reception of gauze andthe upper or protecting and the lower orcuretting edges.

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The free border of the spiral formation is one-fifth ofan inch thick, grooved, with two edges—one blunt tosupport and protect the wall of the uterus, the othersharp, to scrape it.

The spiral is perforated at the top and bottom so thatstrips of antiseptic gauze may be attached to the groove.

My attention was first attracted to the spiral shape ofthe spoon, as I knew it to be t*he only practical base ofconstruction for designs of this character. The idea ofthe screw movement is of course as old as the hills.Archimedes, in the third century before Christ demon-strated the vis e tergo or backward force of a spiral.The ancient Egyptians and Arabic healers applied itsforce in surgical operations, as can be seen by examin-ing the antiquities of the British Museum, or consultingWilkinson’s “Early Memphes”. Why it should everhave been abandoned, when its value was so pre-eminent is a mystery to me. - But to return to the MayCurette; the spiral winds its way easily between theuterine wall, and contents, enfolds and.gets behind theretentions and by its vis e tergo action pushes them out

So powerful is the force of the screw that the slight-est movement of the hand produces intensity of action,yet so even and gentle the pressure that the patient suf-fers no more pain than she would by the movement ofa child in pregnancy.

The blunt edge of the free border or curetting sur-face of the spiral provides a free and easy sliding withinthe uterus, while the sharper edge uniformly does thework of curetting. The groove between these edgescarries the antiseptisized or medicated gauze for topicalapplication. The shield and the groove—without whichno curette could be considered complete—are the mostimportant features of the May instrument. They reducethe pain of manipulation to a nullity , and prevent in avery perfect manner

, injury to the sodden uterine 'walls.The mode of operation is simplicity itself. After the

usual aseptic and antiseptic preparation you place thepatient in a lithotomy position, insert the speculum andsteady the uterus with a vosella, or with one hand on

Fig.4.

Avertical

mesialsectionofthebody

showingthemodeof

operation.TheInstrumentisin

situ;theinternsisemptyand

contracteduponthe

curetteby

reasonofits

adaptabilitytoitscontents.

FIG. 4.

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the abdomen—then introduce the curette at once, if thereis sufficient dilation for expulsion, and if not, you dilatethe os by any one of the various methods in vogue.

Now place the tip of the curette within the uterinecervix and rotate gently to the right two or three times,when the entire spiral formation will be well within thebody of the uterus. Then rotate to the left and rightalternately to loosen everything within the uterus, afterwhich you will find that a slight rotation to the right,accompanied by a gentle traction, expels the debris inentirety.

To me the chief charm of the instrument is its sim-plicity, both in conception and action. Even in thehands of a novice its manipulation would be harmlessand efficacious.

The action of this Curette is clean, swift and sure.It will enter without pain an orifice one-fifth its owndiameter. It embraces all of the requirements necessaryfor emptying, curetting and medicating the uterus per-fectly. It relieves the patient of suffering, and thephysician of trouble and anxiety. Such an inventionmust be a boon to humanity. Long did I seek for sucha complete instrument,and now I have found it; I haveno hesitation in proclaiming its merits and sharing withmy fellow practitioners the benefit of my discovery.

Notwithstanding my appreciation of its excellence, Ihave confined myself to a bald description of its con-struction and mode of operation.

The best test a physician can give an instrument is totry it; if you do so, I feel assured that you will be assatisfied with it as I am, and will thank me for introduc-ing it to your notice.

It is a matter of great congratulation to me that Ihave already received letters of pronounced approvalfrom some of the best known members of the profession,who have been induced by my representations to givethe May Curette and Applicator a trial.

Their hearty indorsement of my statements and un-solicited acknowledgement of satisfaction show that myown judgement was founded on substantial fact, and

that my testimony to the perfection of the instrumentwas not in any way exaggerated.

FIG.S.

Pig. 5. The instrument passed through the cervix, andbetween the post abortive residua and the uterine wall.The spiral in its progress upward has exerted a back-ward force upon the detritus and partly expelled it.

A back and forth rotation will cause the free borderor curetting edge of the instrument to detach any ad-hesions and small retaining particles from the uterinewalls. And the entire debris will come away entwinedaround the instrument,

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I append a few of the many kind expressions of myprofessional friends.

I consider the May Curette and Applicator an invalu-able instrument for removing- secunda and post abortiveresidua, and for uniform distribution of topical applicationswithin the recently impregmated uterus. It is certainly lessdangerous than many of the sharp spoon curettes on themarket, that are misused for that purpose, and is unques-tionably a valuable addition to our surgical armamentary.

Dr. John B. Murphy,Prof. Surgery, College of Physicians & Surgeons [Medicaldepart-

ment State University); AttendingSurgeon Cook Go. Hospital;Alexian Brothers Hospital; West Side Hospital & Post Grad-uate Hospital; Consulting Surgeon St. Joseph’s Hospital;Mem Deutsche Oe.se/Aschaft for Ghirurgical; Society Chirur-gical Paris France; American Association Obst. & Oynec.International Medical Congress.

Case C. Called in consultation, patient about 19 in herfirst pregnancy and syphilitic. Miscarriage in progressduring past week. My colleague, the attendant, finding themembranes ruptured, the foetus dead, and the breach pre-senting at the os, determined on manual extraction, anddelivered the macerated body of a 5 months foetus with ease,but the after coming head was large, and offered great re-sistance, resulting in accidental severance from the body,while still in the uterus. I was called, and confronted withthis trying state of affairs. The woman had fever andrapid pulse, was anxious and nervous. The uterus con-tracted firmly on the severed head and the vagina was hotand dry. I tried manual extraction, but while I couldfeel the head through the os I could not grasp it at all.Then we chloroformed her and tried Loomis’ forceps andBraun’s hook in turn, but all of no avail. As a dernierressortI sent for a May Curette —I did not possess a set of them atthe time—the patient was again chloroformed, I introduceda Sims speculum, placed the tip of the Curette in the os andturned the instrument into the uteruswith the greatest ease.I now steadied the uterus with one hand on the abdomenand with much misgiving and anxiety began my manipu-lation by making two or three turns of the instrument,with slight traction, when to my utter astonishment, andmy colleagues inexpressible satisfaction, the head poppedout of the uterus and rolled upon the floor, speedily follow-ed by the placenta which came away with the withdrawalof the instrument.

Dr. J. B. Wallace, Chicago, 111.

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CaseB. A colleague summoned me to administer chloro-form in a case of miscarriage. He had delivered her of afour mouths foetus; adhesions retained the placenta, andhe wanted to resort to manual extraction. He could feelthe placenta withhis finger, but could not extract it with-out introducing the hand. I related my experience in simi-lar cases by the use of the May Curette;, and upon hissuggestion returned to my office to get it. He wanted me toperform the operation, but finally I induced him to try it.We placed our patient crosswise on the bed. He readilyentered the uterus with the instrument, rotated it back andforth with slight traction, and out came the entire placentaand membranes. My colleague was delighted, withoutanaesthesia, without pain to the patient, without any fussor disturbance, he had removed the obnoxious retention with-in five minutes time. “I’ll buy one of those Curettes,”he said. “ before I go home.”

G. Stafford, M. D., Des Moines, lowa,

In regard to the May Curette and Applicator, let mesay, that I have used the instrument for the removal of thesecundines after abortion, and have found that it answersthe indications very well.

A. B. Marcusson, A. M., M. D,,Surgeon in Chief Red Gross Medical Service.

Case F. Patient was in labor 24 hours. On examin-ation I found a brow presentation; applied the forceps, anddelivered herunder Chloroform anaesthesia. The placentacame away and the uterus contracted in the usual and nor-mal way. Thinking all was well I left the nurse in chargeof the patient, and departed. I had gone but a block whena messenger overtook me, excitedly bade me return at once,the patient was dying. I hurried to the house and foundher in a precarious state; the uterus had relaxed, filled withblood, and a profuse post-partum hemorrhage had all butbrought the dreaded scepter to her door. Luckily for hersafety, and my reputation, I had with me a large MayCurette and a bottle of Monsells Solution. I saturated astrip of gauze with the solution, wound it around in thegroove of my curette and turned it into the bleedinguterus, rotating it alternately from right to left and fromleft to right. The instrument simultaneously forced outthe blood clots, and swabed the bleeding mouths of the ves-sels with the iron solution; the result was marvelous; the

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flow checked instantaneously, and the uterus contractedfirmly upon the instrument; I allowed the curette to remainwithin the uterus, and turned my attention to restoring' mypatients vitality; after a lapse of 10 or 15 minutes I removedthe instrument carefully, and left the room, one hour laterI left the house. Her recovery, although slow, was com-plete.

Dr. Samuel B. Ellis, Dayton O.

I have used the May Curette and Applicator in a num-ber of cases; I consider it a safe and useful instrument,admirably adapted for the purposes for which it is intended,and a scientific advancement over previously employedmethods.

Dr. P. F. Schemes, 400 N, Ashland Ave., Chicago.

Case A, Period of gestation 9 weeks. Patient has beenflowing more or less during the past 10 days.—On examin-ation I found the vagina full of coagulae, the os soft andplatulous, and the uterus sensitive. She had temperatureof 102; chills; a rapid feeble pulse, blanched features, andextreme exhaustion. After the usual preparation I intro-duced the small May Curette and quickly removed a largeamount of offensive detritus. The patient’s conditionchanged like magic and in three days she was doing lighthouse work. In conversation with her later she informedme that she suffered no pain during the operation.

Dr. J. M. Lynch, M. D. 116 128th St., New York.

Case D. On May 10th Mrs. E. R. age 28, called at my of-fice for treatment; she said she missed her regular period,and two weeks later while cleaning house became unwell;has flowed profusely and continuously during the past 10days. Complained of pain and heaviness in the pelvic re-gion, constipation, anorexia and headache. I suspectedabortion but could not get her toconsent to an examination,because she believed impregnation had not occured; she re-mained obdurate, and finally caused meto prescribe internalmedicine for her, without examination. My treatmentavailed little or nothing, and on her third visit I gained herconsent to an examination upon the promise that I wouldnot scrape her womb, stating that she had that done a fewyears ago and could not again endure the pain. I placed her

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on the chair, produced a small May Curette with gauze attach-ed, and told her that I would put medicine on the cloth and ap-ply it to her womb with the instrument. Upon her consent,I moistened the gauze on my Curette with lodineand intro-duced the instrument into the uterus, made a few rotationsand withdrew it. I found entangled upon my instrumentwhat proved to be the debris of a recent ovum. What agrand invention; what a happy thought the constructionof the May Curette really is. The most enthusiastic can-not praise it beyond its merits. In this case I purgedthe uterus of its refuse, and applied lodine simultaneously,and that so quickly and gently that my patient was not evenaware of what had been done, although she soon realizedthat “that office treatment” completelyrestored her health.

Dr. F. G. Huwatsciiek, Eversonville, Mo.

I have thoroughly tested the May Curette and Appei-caTok; have used it as a curette, as a medicator and as bothcombined, I have removed wholeplacentae, placental frag-ments, ovums and membranes; have checked uterinehemorrhages, sepsis and endometritis by the use of it andwill state that I consider the instrument ne plus ultra.

J, H. Thomas, M. D.,360 Bine Island Ave., Chicago.

I was among the fortunate first ones to procure the MayCurette and AppeicaTor, I have used it much and am per-haps an enthusiast regarding its merits. Nevertheless Iperdict that the time will come when this instrument willbe indorsed in every text book on midwifery and gynecologyin the world.

Albert W. Moore, M, D., Bristol, 111.

An incident occurred in my practice which illustrates thedesirability to possess the May Curette, when occasion re-quires it. Sometime ago I attended a patient in miscarriage,the foetus was expelled,but the placenta retained,so I decidedto wait on nature and tamponed the vagina—this was beforeI had acquainted myself with the May Curette—after alapse of an hour the family grew apprehensive and calledin another physician. Upon his arrival, he promptly eva-cuated the uterus with the May Curette and thereby wonthe confidence of my patient and received his fee, whileI lost both.Charles E. Kreml, M. D., BBS W.lSth St., Chicago.