AN ADENOID CURETTE.

228 into the rectum. The crank handle is made for the purpose of having the instrument conveniently at hand for manipulation in front of the patient’s thigh. The curved processes, one on each side of the handle, are for the purpose of preventing the instrument rolling between the patient’s thighs when the surgeon is not using it. As soon as the bladder i-; opened the spoon is passed into the rectum and the patient’s thighs are approximated; under these conditions it will remain in situ and quite out of the way. The surgeon can perform all the necessary manipulations without infecting his hands and the instrument answers the purpose better, I think, than the fingers of an assistant in the rectum, because the operator acts directly on the spoon; he can push it up or draw it down to the exact position at which he requires the rectal counter-pressure ; it can also be tilted to either side so that elevation of any particular area of the

posterior wall of the bladder be regulated to a nicety, for every movement of the handle is transmitted directly to the spoon as it is specially made in one solid piece for that purpose. I have used it in three prostatectomies and in one case of evacuation of blood clots completely filling the bladder. In the latter case the clot was cleared out through a uprapubic wound with great ease and rapidity by means of the spoon in the rectum and suprapubic massage of the abdomen. In a case of prostatectomy upon a friend of Dr. W. T. Edwards, J.P., I was able to remove 47 calculi from a large post-prostatic pouch which I could not otherwise rcach with mv fingers. In one of the other cases there was a calculus weighing two ounces and its delivery was facilitated by usirg the spoon in the rectum. In operations upon the female pelvis I introduce the spoon into the vagina and it remains in situ until required for lifting the uterus, Douglas’s pouch, or the bladder. The particular point at which lifting of the pelvic floor is required is easily obtained. In a case of cceliotomy for soft, friable, and separate malignant growths of both ovaries secondary to carcinoma of the stomach I found it very useful as the tumours would not withstand any traction upon them for delivery. The face of a hysterectomy or of an ovarian stump can be easily manipulated so as to give a better view for its inspection by means of the spoon in the vagina. The reason that I record my hort experience of the uses of the spoon is due to the fact that Messrs. Weiss informed me that they had sold several of them after I referred in a PS. to a paper on Prostatectomy to the fact that I had used such an instrument. The instrument which I had used at that time and those which have been sold are only three centimetres wide, but in practice I soon found that this was not broad enough for cases of enlarged cervix ueri or of a very big prostate to hold them firmly during lifting of the pelvic floor, as they had a tendency to slip over to one side. The instrument which is described above is four centimetres wide and is more satisfactory on account of its increased breadth. J. LYNN THOMAS, C.B., F.R.C S. Eng. Cardiff.

without the slightest risk of wounding any important structure except the projecting adenoid mass. I have never known of any ol erator reverting to the older instrument when once he became used to a satisfactory form of curette. The original Gottstein form, although it detached the growth, had the drawback of not bringing it away, while there was some anxiety of the detached adenoid mass embarrassing the respiration. This objection was overcome by Delstanche’s ingenious idea of connecting a hinged and toothed cage to the curette so as to receive the growth. As fitted to the original Gottstein model the toothed cage did not always appear to give sufficient space fully to receive the growth; it became too "crowded," in fact. Beides, the e Gottstein form, to which it was attached, ends below in a V point, so that much of the lateral masses of a large square growth might easily escape the first stroke. The Beckmann curette, with its quadrilateral fenestra, and its curve adapted to the roof of the naso-pharynx, is better suited to embrace the adenoid mass. To this curette I have had fixed a hinged,

base and can

spring frame, armed with short curved teeth set close together. This will admit a ma-sof any size and will prevent it from falling out of the curette. For the usual light handle I have substituted a more solid one, which can be grasped dagger-wise. Held in this position it is easier to keep the

instrument all the time in the middle axis of the body ; there is no uncertainty as to where the cutting edge exactly is when out of sight (which may happen if the curette is held like a pen, when it may easily become rotated in the fingers), and the growth can be more completely shaved off by one firm stroke. When the main growth has been removed an ordinary small Beckmann curette (18 millimetres across), fitted with a stout handle, will be found satisfactory for removing any lateral prolongations which have escaped the caged instrument. Thinking that better work could be done the larger the instrument employed I -tried various sizes, including one measuring one inch across. But this proved useless, and one stock size, measuring three-quarters of an inch (20 millimetres) across, has been found the mot satisfactory for all well-marked hypertrophies. A smaller curette, measuring 18 millimetres across, can be used for more limited growths, but the ordinary size is quite suitable for children three years of age, as well as for adolescents, the choice of instrument depending more on the size of the hypertrophy than on the age of the patient. This instrument was designed about eight years ago. I am informed that it is the one most generally used in the two chief throat hospitals as well as in many of the special clinics of the general hospitals. It is manufactured by Messrs. Mayer and Meltzer who report that they sell rrore of this model than of any other. It has therefore had an extensive trial before I ventured to bring it before the profession. STCLAIR THOMSON, M.D. Lond. Queen Anne-street, W.

AN ADENOID CURETTE. of a curette for the removal of naso-pharyngeal adenoids, in preference to the various forms of post-nasal ROYAL PORTSMOUTH HOSPITAL. A bazaar, forceps, has now become almost universal. Most surgeons under Royal patronage, which extended over four days. was who have been performing this operation for more than ten opened by Lady Northbrook at the Town Hall, Portsmouth. years commenced with some form of Loewenberg forceps and on July llth. Apart from its success as a bazaar the effort have gradually discarded it for the curette. The curette will stand out prominently in the annals of Portsmouth, for it took also the form of a celebration of the centenary of removes a growth so rapidly and completely that the time occupied is very short and the risk from haemorrhage is Nelson’s great and glorious victory, and the navy and army. greatly lessened. For those whose dexterity is not main- with the representatives of civilian life, peacefully observed tained by frequent practice the curette is also a much safer it by doing all in their power to increase the mayor’s fund instrument. Once introduced behind the soft palate and for building a new operating theatre and a block of wards carefully maintained in the middle line of the body it can be at the Royal Portsmouth Hospital. It is expected that a swept backwards and downwards along the naso-pharynx sum of E1800 will be realised. THE

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