Paul R. Dittmer
Published: 1993-10-27
Total Pages: 584
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This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1911 edition. Excerpt: ... EXAMINATION A curetment should never be looked upon as an operation of indifference. With the introduction of instruments into the uterus, infectious micro-organisms may seize the opportunity for travel; with the scraping of the wall by the sharp curet, vascular channels are easily opened, minute wounds made, through which the infection hastens. Inflammatory processes, chiefly of the parametrium, are the sequelae. Curetment, or abrasio mucosae, should, therefore, never be undertaken save where the strictest conditions of asepsis and of antisepsis prevail; the hands of the surgeon and the territory invaded are to be made ready as for an "operation," and the instruments sterilized. Moreover, this surgical interference should be limited to "clean cases," for, as a rule, it is contra-indicated where recent inflammatory processes in the small pelvis (salpingitis, parametritis) are demonstrable, as such intra-uterine invasion very possibly aggravates the conditions already present or, at least, augments the pains. The symptom which, almost exclusively, justifies an abrasio mucosae uteri or curetment, is: hemorrhage. This may develop as menorrhagia or as metrorrhagia or, mixed with fragments of ovum and decidua, it may indicate an incomplete abortion. Recognition of an abortion offers, in most cases, no difficulty, and, this condition having been ascertained, a curetment for removal of the fetus and membranes may be done, special attention being given to all precautionary measures (large curet; care when working in the fundus; operation only in 3 the first eight or ten weeks of pregnancy). Yet, there are hemorrhages during pregnancy, which, without further consideration, are cognized as such, viz., when sequent to an abortion during the first...