[Reprinted from the American Gynaecological and Obstetrical Journal 
for July, 1895.] 
THE UTERINE SOUND AND CURETTE.* 
By W. M. Catto, M. D., Decatur, III. 
The sound and curette are instruments with which every physician 
is more or less familiar ; they are made of a variety of materials, and 
of different sizes and shapes, each of which has its advantages in 
special cases. 
Both instruments are used as a means of diagnosis and treatment; 
their range of application is wide but limited, and, although their 
judicious use results in great benefit, there are perhaps no two in- 
struments in the physician's armamentarium capable of producing 
more disastrous results when carelessly or unskillfully handled. 
The typical sound is that of Sir James Simpson. It should be 
made of flexible material capable of being readily bent with the 
fingers, but of sufficient rigidity to withstand a moderate degree of 
pressure. In most cases this is the best sound, but when the cavity 
of the uterus is tortuous, as in a submucous fibroid, Emmet's sound 
should be used, as also Emmet's fine probe in exploring for the posi- 
tion of the uterus. 
As a means of diagnosis the sound is almost indispensable in 
many forms of uterine trouble. With it we may determine the length, 
shape, and direction of the uterine canal ; the presence or absence of 
abnormal tenderness; the condition in a measure of the uterine mu- 
cosa; the presence or absence of atresia, stenosis, granulations, and 
tumors; fixity or freedom of the uterine body; when a tumor is pres- 
ent, its size, shape, and situation as related to the uterus; its fixity, 
density, and probable character. 
No force should ever be used in the introduction of the uterine 
sound, and it is needless to say it should always be surgically clean. 
In displacements of the womb, either backward or forward, we 
are enabled by its use to determine whether we have a flexion or 
* Read before the Tri-State Medical Society, at St. Louis, April 3, 1895. 
Copyright, 1895, By J. D. Emmet, M. D. 2 
W. M. Catto, M. D. 
version, a point not always easy to determine by other means; not in- 
frequently the neck of a small uterus will occupy a normal position, 
but the body be difficult to find from deposit of adipose or other 
causes, and upon the introduction of a sound we may find an acute 
flexion which has been the cause of a distressing dysmenorrhoea, or 
even cystitis. So also, by using the probe, what may have been an 
apparent stenosis at the internal os will be found to be an acute 
flexion, which, when relieved, all symptoms of stenosis disappear. 
As regards the condition of the uterine mucosa, the proper intro- 
duction of the sound into the cavity of the uterus should not cause 
any flow of blood when the instrument is withdrawn if the membrane 
be healthy; nor should the touch of the sound against the fundus 
produce pain or tenderness as it would in a case of endometritis. 
If blood follows the withdrawal of the sound, it is indicative of 
granulations, endometritis, or the near approach of menstruation. 
In fibroid tumors of the uterus, either submucous or intramural, 
the sound, by the distance it enters and the direction it takes, indicates 
the probable size and position of the tumor, as to whether it occupies 
the anterior or posterior wall ; it tells the degree of solidity, smooth- 
ness of outline, and sometimes the presence or absence of a pedicle. 
In cases where doubt exists as to the position of a small fibroid, 
the sound in the cavity of the uterus, brought well up against the ab- 
dominal wall to meet the hand placed externally, as in a bimanual ex- 
amination, will often clear up the doubt. 
With the sound we can sometimes distinguish a haematoma from a 
uterine tumor; also in doubtful cases whether a tumor be uterine or 
ovarian. 
By the careful use of the sound we may determine whether the 
uterus is free or bound down by adhesions, and in the latter case 
whether the adhesions are firmly fixed or elastic and yielding, whether 
they surround the organ or are confined to one side; also to what 
structures it is probably attached. 
The instrument is also useful in making a diagnosis between poly- 
pus and an inverted uterus. In the latter condition, upon endeavor- 
ing to enter the sound, it meets with obstruction all round ; while in 
the former the sound will usually pass on one side of the tumor, and 
to a greater distance than normal, as the uterus is enlarged. 
As a means of treatment, the use of the sound is much more 
limited. 
It may be used to partially overcome a moderate degree of stenosis. 
With it we may replace and momentarily retain in position a uterus The Uterine Sound and Curette. 
3 
that is "verted" or flexed and not bound down ; when adhesions ex- 
ist, reposition should be accomplished by other means. 
It is useful in making medicinal applications to the endometrium. 
A knowledge of when not to use the sound is fully as essential as 
to know when and how to use it properly. 
It is an unsafe instrument to use when a healthy woman has 
missed her regular menstrual period from any given cause, and should 
not be passed without satisfactory evidence that pregnancy does not 
exist. 
It should not be used during menstruation, and should never be 
employed to replace a uterus that is firmly bound down by adhesions; 
there is danger of penetrating the organ or of injuring the endome- 
trium. 
The sound should never be heedlessly introduced into the uterine 
cavity of a patient suffering from an acute or latent gonorrhoea either 
of the vagina or cervix. I am inclined to believe that more harm is 
done by its use in this class of cases than in any other, and the physi- 
cian should satisfy himself in every case, if possible, that no such 
condition exists before passing the sound either for the purpose of 
diagnosis or treatment. 
In such cases there is great danger of lighting up a violent specific 
inflammation in structures that Nature seems to have fortified against 
the entrance of the poison, and most physicians of experience can 
call to mind cases in which the introduction of a sound into the uterus 
of a patient having gonorrhoea has resulted in an acute metritis, sal- 
pingitis, and ovaritis, ending in loss of ovarian function, of the organs 
themselves, or even sometimes of the patient's life ; and this, too, 
when the disease had been present in the vagina and cervix for some 
time without doing any apparent great harm. 
The curette is more frequently used as a means of treatment than 
of diagnosis, although in the latter case it is useful in removing tissue 
from the cervix or uterine cavity, for chemical or microscopical ex- 
amination in cases where the nature of the disease is doubtful. 
Many forms of this instrument have been devised, all of which 
seem to have their disadvantages ; it should be slightly flexible, but 
not too easily bent. 
We are frequently told by authorities that the best curette is the 
finger ; and, theoretically, this may be true, but practically it is not 
the case, as nineteen times out of twenty, where the use of the curette 
is indicated at all, the finger could not be used. 
A finger, to make a good curette, should be about half the cir- 4 
W. M. Catto, M. D. 
cumference and three or four times as long as the ordinary index 
finger. 
Probably the safest and best instrument for ordinary use is the 
dull, spoon-shaped, irrigating curette. 
Its chief use is to remove from the uterine cavity any substance 
that is causing or likely to cause mischief, such as granulation tissue, re- 
tained placenta, shreds of membrane, foreign bodies, small tumors, etc. 
Much difference of opinion exists as to the proper time to insti- 
tute mechanical interference for the removal of the placenta or other 
retained products of conception after miscarriage. 
Generally, all such should be thoroughly removed by curetting 
and irrigation, if necessary within twenty-four hours after the escape 
of the foetus; the use of the dull curette with antiseptic irrigation will 
render the patient safer and the physician more comfortable, whether 
urgently demanded or not. 
When, however, a case has been neglected until absorption of sep- 
tic matter has begun, no time should be lost in removing all offending 
material that may be in the womb. 
In those cases of granular endometritis often following miscar- 
riage and sometimes labor at full term, accompanied by a condition 
of subinvolution and characterized by menorrhagia at each menstrual 
period, which latter is likely to be irregular and prolonged, the use of 
the curette aids very materially in bringing about a cure. 
The instrument may be used with advantage in some cases of 
cancer where, owing to the advanced stage of the disease, or to other 
causes, palliative measures only can be used. 
In conclusion, the curette is almost the only reasonably sure means 
by which we can cure that most painful and persistent malady-mem- 
branous dysmenorrhoea. This has resisted nearly all known remedies, 
rational and irrational, but will yield to thorough curettement, followed 
by the application of tincture of iodine, practiced five to eight days 
after the cessation of the menstrual flow. 
The curette should not be used in that class of cases where the 
use of the sound would be contra-indicated, the same objections 
applying with even greater force to the curette than to the sound.