Endometritis Fungosa 
ITS PATHOLOGY, DIAGNOSIS, AND 
TRE A TMENT 
BY 
JAMES B. HUNTER, M. D. 
SURGEON TO THE WOMAN'S HOSPITAL, NEW YORK ; PROFESSOR OF GYNECOLOGY 
IN THE NEW YORK POLYCLINIC, ETC. 
Reprinted from The Medical Record, April 25, 1885 
NEW YORK 
TROW'S PRINTING AND BOOKBINDING CO. 
201-213 East Twelfth Street 
1885 Endometritis Fungosa 
ITS PATHOLOGY, DIAGNOSIS, AND 
TRE A TMENT 
BY 
JAMES B. HUNTER, M. D. 
SURGEON TO THE WOMAN'S HOSPITAL, NEW YORK ; PROFESSOR OF GYNECOLOGY 
IN THE NEW YORK POLYCLINIC, ETC. 
Reprinted from The Medical Record, April 25, 1885 
NEW YORK 
TROW'S PRINTING AND BOOKBINDING CO. 
201-213 East Twelfth Street 
I88S ENDOMETRITIS FUNGOSA ; ITS PATHOLOGY, 
DIAGNOSIS, AND TREATMENT.1 
The disease known to us as endometritis fungosa was 
described by Robert, a pupil of Recamier {Bill. Therapeut., 
1846, tome 21). Recamier himself wrote on the sub- 
ject, under the title of " Fongositees Uterines," in 1850 
{Union Med de Paris, tome 1, 1850). In 1848 Robin 
{Arch. Gen. de Medicine, xvii.) said of these fungosities: 
They are, from an anatomical standpoint, simple vegeta- 
tions from the uterine mucous membrane, having therefore 
the same anatomical composition, and enclosing fibro- 
plastic tissue." 
Rouyer ("These de Paris, 1848") says: "The frag- 
ments made with a curette are generally from three to 
five centimetres long ; from five to six millimetres wide, 
and from one to five millimetres thick. Their free sur- 
face is smooth, and covered with epithelium ; the tissue 
is very vascular. In this hypertrophied mucous mem- 
brane there appear granular forms of three kinds, viz. : 
1, Granules which resemble small gooseberry seeds, and 
are opacpie or transparent-these raise up the mucous 
membrane, and form white spherical, almost sessile, pro- 
jections ; 2, masses of a spongy character, like placental 
tissue ; 3, granules about as large as the head of a pin, 
which are seen beneath the mucous membrane. These 
may attain the size of a pea, and resemble the forms 
described, except that they are more numerous and regu- 
larly distributed. 
Nelaton {Gazette des Hopitaux, 1853, No. 17), states 
1 Read before the New York Academy of Medicine, April 16, 1885. 4 
that fungosities have two surfaces-a free surface, which 
is of a rosy red color, and growths resembling the intes- 
tinal villi, and an attached surface, the latter having a 
deep red shade, and suggesting freshly torn tissue. 
Fenier ("Th^se de Paris, 1853") had an opportunity 
to observe these growths in situ, on several occasions, in 
the dead-house. He describes them as small, spongy, 
pulpy masses, red or rose-colored, soft, easily detached 
with the finger-nail, with or without pedicles. 
Goldschmidt (" These de Strasburg, 1859 ") states that 
Koeberle found them fifteen times in the cadaver. 
Richet, Robert, and Nelaton all took opportunities to 
study this condition at autopsies. For the gross pathol- 
ogy of this affection we are indebted largely to early 
French observers, and some after them recognized its 
nature quite clearly. The German authorities have in- 
vestigated more thoroughly the microscopical anatomy 
of the subject; Olshausen (Archiv fur Gynakologie, vol. 
viii., No. 1) having contributed the most important 
paper. 
Among those who have written on the subject are 
Aran (" Mal. de 1'Uterus") ; Courty (" Mal. de 1'Uterus"); 
Gallard, Ruge and Veit; Nonat ("Mal. de 1'Uterus ") ; 
and Winckel, under the title of " Adenoma Papillosum 
Diffusum Corporis Uteri." The disease does not seem to 
have been studied or appreciated by the English authori- 
ties. In this country it has long been recognized and 
successfully treated. 
There is some confusion as to the term " fungosity." 
Olshausen writes of " endometritis hyperplastica chronica 
vel polyposa ; " Hegar and Kaltenbach include the con- 
dition under "endometritis;" Weber refers to it as 
" endometritis hemorrhagica ; " Slavjansky employs the 
term " metritis villosa ; " Courty treats of granulations 
and fungosities, and considers fungosilies a development 
of granulations. Throughout his whole chapter on this 
subject, Courty singularly confounds fungosities of the 
uterine cavity with erosions, and with hypertrophy of the 
follicles of the cervix. According to my experience 5 
fungosities proper are never found in the canal of the 
cervix, though often abundant just above the boundary- 
line between the cervix and the body of the uterus. 
They are certainly never found, as Cdurty seems to be- 
lieve, " commencing at the os uteri." 
Pathology.-If the lining membrane of a uterus which is 
the subject of fungosities be gently scraped with a blunt 
curette there will appear, together with some blood-clots, a 
number of small, pink, firmly organized bodies, sometimes 
gelatinous, resembling small polypi, and varying from the 
size of a pin's head to that of a small pea. I have seldom 
found them to exceed five millimetres in size, and, as a 
rule, they are much smaller. They cannot be easily broken 
down by the finger, and are very easily distinguished from 
blood-clots when put into water. Neither the size of 
these growths nor their number is in proportion to the 
amount of hemorrhage to which they may give rise. The 
scraping, if carried over tjie whole surface of the uterus, 
will generally exhibit a few whole fungosities and a quan- 
tity of fragments, mixed with blood-clots. The true 
fungosity is always of a pale pink color after removal, 
but is probably congested while attached to the mucous 
membrane of the uterus, as the structure is highly vas- 
cular. Aran divides fungosities into sessile tumors, 
with broad bases, and pediculated or polypoid masses. 
Munde {Edin. Med. Jour., April, 1878) speaks of three 
varieties, including " uniform hyperplasia of the entire 
mucous membrane," which, pathologically speaking, is 
questionable. The difference between sessile and pedi- 
culated fungosities is one of form only. All fungosities 
consist essentially of a hypertrophy of the muco'. s mem- 
brane, in the form of papillary growths having a distinct 
fibrous basis, and covered by a single layer of cylindrical 
epithelial cells. I have examined a large number of 
specimens microscopically, and have often found these 
characteristics so distinct, and accompanied by so great 
an increase in the size of follicles, as to offer some ground 
for considering them new specimens, which might be re- 
garded as adeno-papillomata. The abundant vascular 6 
supply of these fungosities has been well described by 
Olshausen, who also notes the constant presence of num- 
bers of leucocytes, which not only crowd the interstices of 
the fibrous tissue which forms the bulk of the fungosities, 
but are also found abundantly in the surrounding mucous 
membrane. The presence of these white blood-corpus- 
cles in unstained specimens often gives an appearance 
which it is extremely difficult to distinguish from that of 
round-celled sarcoma. De Sin^ty (Paris, 1879) is the 
only author who has laid stress upon the close resem- 
blances of fungosities to true granulation tissue. He 
says : " In other cases the fungosities are specially con- 
stituted of embryonic tissue with few blood-vessels. 
There are only traces of the glands, and some remains of 
more or less degenerated epithelium. We have then to 
do with a truly inflammatory tissue, and comparable to 
that which remains upon an exposed wound. At certain 
points there are islands of degenerated elements which 
are not colored by reagents, and are analogous to those 
observed in foci producing pus." This statement is im- 
portant, as showing that we have to deal with something 
more than simple hypertrophy. Thomas, in using the 
term " fungous degeneration," does not mean to imply 
that there is any process akin to degeneration in the de- 
velopment of fungosities, which are really local hyper- 
trophies of the uterine mucous membrane. Fungosities 
are never friable, and never show evidences of degenera- 
tion. They are not homogeneous on section, and con- 
tain a good deal of fibrous tissue. 
The question naturally arises, why the hemorrhage 
should be so great, as we know it to be clinically, from a 
cause apparently so trifling. The amount of hemorrhage 
will not appear excessive if we consider the extent of 
surface from which it springs. In normal menstruation 
the escape of blood occurs because of the fatty degenera- 
tion of a portion or of the whole of the epithelial lining of 
the uterus (Kundrat, Leopold, Engelmann). The epi- 
thelial covering of these fungosities probably undergoes 
the same change as that of the rest of the mucous mem- 7 
brane. In the diagram before you, which is probably 
not exaggerated as to proportion, the distance from A to 
B is about six inches. The surface of this fungosity 
measures ninety-six inches ; so that it is evident that the 
superficial area of the cavity of the uterus may be 
enormously increased by the existence of a small num- 
ber of fungous growths. The extreme vascularity of the 
growths under consideration is not apparent in sections 
of specimens that have not been injected. The oppor- 
tunity for obtaining such specimens is very rare. The 
question of the cause of the prominent symptom, hemor- 
rhage, has been avoided by all the authors I have con- 
sulted who have written on this subject. 
Microscopic appearances.-The actual appearance of 
these growths under the microscope has not been satis- 
factorily described, notwithstanding the vital importance 
of distinguishing between endometritis fungosa and ma- 
lignant disease of the uterus. Unaided by the history 
and clinical features of a given case it is not always pos- 
sible, by the microscope, from a single small specimen, 
to make an absolute diagnosis, even for the most experi- 
enced microscopists. In a typical case, and under 
favorable circumstances, there would be little difficulty in 
doing so. While a diagnosis of sarcoma or epithe- 
lioma may often be made from the examination of a 
single specimen, it may be necessary to examine a num- 
ber of specimens in order to certainly exclude those dis- 
eases and pronounce a diagnosis of an innocent affec- 
tion. 
The papillomatous masses are absolutely characteristic 
of fungosities, even if there should be no enlarged glands 
and other appearances characteristic of uterine mucous 
membrane. This, taken in connection with the amount 
of fibrous tissue, the glands, etc., will generally suffice for 
a diagnosis. On staining, the smaller size and irregu- 
lar distribution of the leucocytes will exclude sarcoma- 
tous tissue. In cases where characteristic sections can- 
not be obtained the diagnosis must be guarded. 
According to Olshausen, microscopical examination 8 
shows a greatly hypertrophied mucous membrane with 
increase of all its elements, dilated follicles, enlarged 
blood-vessels, and great cell infiltration of all the connec- 
tive-tissue. There are large dilated blood-vessels, and 
around them many white blood-corpuscles. Around 
the i follicles are spindle-cells arranged in regular lines. 
"These," he says, "prove the chronicity of the affection." 
I have quite recentlyhad an opportunity of examining, 
post-mortem, a perfect specimen of fungosities in situ 
that presented the appearance of very small dentritic 
masses, pale and shrunken, covering the greater part of 
the anterior wall of the uterus. A number of sections 
made by Dr. H. C. Coe, through the entire uterine wall 
of a similar case, including the basis of the growths, 
showed conclusively that there was no line of demarca- 
tion between the normal hypertrophied tissue, but that 
the uterine mucous membrane was continuous with that 
covering the fungoid masses. The submuqous connec- 
tive-tissue extended directly into the masses, giving an 
appearance suggestive of the benign growths in the blad- 
der figured by Thompson as " fibro-papillomata." 
Important as the microscope is to enable us to form a 
diagnosis of this affection, much care and patience is 
necessary in its use. A hasty examination of a single 
section, especially a fresh one, is by no means sufficient. 
Specimens should be examined both fresh, and also hard- 
ened in alcohol, and stained. At least a dozen different 
sections should be looked over carefully and compared 
with each other, or other specimens and plates. Such 
an examination, together with the history of the case, 
will generally enable us to make a positive diagnosis. 
Symptoms.-The principal symptom of this form of 
endometritis is menorrhagia. Rouyer makes the ques- 
tionable statement that pain is always present, and that 
it is generally unilateral, radiating from the iliac region to 
the sacrum and hip of the corresponding side. I have 
found pain to be rare as a consequence of the existence 
of fungosities. As a rule, the hemorrhage consequent 
upon fungous growths is a menorrhagia-that is, it con- 9 
sists in an increase of the quantity of the normal men- 
strual flow, and especially in a lengthening of the period, 
which instead of five may last eight or ten days or more. 
In sarcoma there is generally a metrorrhagia, which occurs 
independently of the menstrual period, and which often 
breaks up entirely the menstrual rhythm. A long train 
of symptoms follow, but they are in nowise different 
from those common to anaemia from other cases. 
In some cases there is in place of hemorrhage a con- 
stant discharge of serum, perhaps only tinged with blood. 
The subjects of such watery discharges lose flesh and 
strength and become anaemic, as though the loss were of 
blood. 
According to Olshausen the increased flow due to 
fungosities often comes on suddenly in women previously 
healthy, and causes an anaemia, as a result of which 
there is an absence of menstruation for several months. 
This is directly contrary to my experience. 
Lusk reports a case {Am. Jour. of Ob stet., January, 1878) 
which died from progressive cachexia, probably from the 
existence of fungosities. Dr. M. D. Mann, who exam- 
ined the uterus, post-mortem, pronounced the case one 
of " villous degeneration of the uterine mucous mem- 
brane." He says of the specimen examined (Trans. 
Obstet. Soc., Am. Jour. Obstet., January, 1878, p. 133), 
" it consists histologically of structureless basement sub- 
stance containing great quantities of small round cells 
and nuclei, and portions of uterine follicles and vessels." 
Etiology.-The growth of fungosities seems to be gen- 
erally a result of chronic congestion of the uterus. It is 
commonly found in cases of subinvolution. In unmar- 
ried women it is often a consequence of neglected retro- 
version or retroflexion. In cases of laceration of the 
cervix, where there is much hypertrophy of tissue, there 
is commonly an interference with the circulation, which, 
if sufficiently prolonged, promotes these vascular growths 
from the endometrium. They seem to result from a 
moderate amount of congestion, as from a mild form of 
endometritis, long continued, rather than from the more 10 
severe or acute forms of that disease. They have no 
connection whatever with gonorrhceal or syphilitic infec- 
tion, as far as I have been able to ascertain. They oc- 
cur usually during the child-bearing period, but may be 
found before and after that time. It is some aid in di- 
agnosis to remember that sarcoma, as a rule, does not 
occur till between thirty-five and forty. 
One of the causes of hyperaemia of the uterus is the 
existence of fibroid tumors in connection with that organ. 
Hence fungosities are often found associated with fibroid 
tumors, and in some cases are the chief cause of excessive 
hemorrhage. They should always be suspected in cases 
of fibroids, as their removal may be of great temporary 
benefit to the patient. 
Differential diagnosis.-The conditions with which 
fungosities are liable to be confounded are : 
i. Benign growths, A. Submucous polypus; B. 
Adenoma of the uterus ; C. Benign papillomata; D. 
Villous degeneration of the endometrium ; E. Placental 
or decidual remains. 
2. Malignant growths, A. Carcinoma of the body of 
the uterus ; B. Round celled (or diffuse) sarcoma. 
Benign Growths.-A. Fragments of soft myxomatous 
polypi removed from the uterine cavity sometimes resem- 
ble fungosities on gross inspection. Under the microscope 
the loose fibro-muscular tissue, the enclosing layer of epi- 
thelial cells, the enlarged blood-cells, and the free leuco- 
cytes give an appearance which might easily be mistaken. 
A few stained sections of the suspicious masses will bring 
out the well marked papillary remains, and clear up the 
diagnosis. The rare form known as " channelled poly- 
pus" is distinguished by the presence of a large number 
of cavities of a size never seen in true fungosities. 
Klob describes a vesicular polypus which seems to be of 
the same character as the variety just named. Polypi 
are more limited in number, and more localized. They 
are often found in the cervix, while fungosities are not. 
B. Adenoma of the uterus is a rare condition, and the 
descriptions of it are vague. Savage seems to regard it 11 
as not uncommon, but he evidently confounds it with fun- 
gosities. 
C. True benign papillomata are said to be confined 
to the cervix, while fungosities are, in the opinion of 
all authors except Courty, limited to the body of the 
uterus. The microscopical differentiation of these two 
conditions would be difficult, if not impossible. It is a 
question whether some of the large fungoid growths 
should not be regarded as true morbid growths rather 
than simple hypertrophies. 
D. Goodell refers to a condition which he calls vil- 
lous degeneration of the endometrium, the same being 
described by Hirschfeld as " cylindrical cell adenoma," 
and by Winkel as " adenoma papillosum diffusum corpus 
uteri." The cases described by Goodell were probably 
either villous cancer or simple fungosities. 
E. The diagnosis of fragments of placental polypi or 
retained decidual remains is not easy. The embryonic 
cells of foetal remains are larger than those covering the 
fungoid masses. The cells covering fungoid masses are 
cylindrical, and the connective-tissue basis is firmer and 
more pronounced than in the chorionic villi. The latter 
are generally longer and more delicate, and have clubbed 
rather than accuminate extremities. 
Malignant Growths.-A. Epithelial or medullary carci- 
noma of the body of the uterus is so different in its history, 
and so different microscopically, that there is little danger 
of confusion. The cells of an epithelial type, infiltration, 
excessive degeneration, alveoli, fragments, etc., are suffi- 
cient to make the diagnosis of carcinoma easy. 
B. Round-celled sarcoma of the uterine mucous mem- 
brane is more likely to be mistaken for fungosities 
than any other condition. Sarcoma of the body of 
the uterus is not so exceedingly rare as it is stated to 
be by Dr. Munde in his article already quoted, in which 
he says that Schroeder has found only sixteen cases re- 
ported in literature. I have seen seven cases in my own 
practice, and in that of Dr. Thomas, in the Woman's 
Hospital and elsewhere, I have seen twice as many. Dr. 12 
Coe, Pathologist to the Woman's Hospital, has examined 
six cases, in which there could be no doubt of the diag- 
nosis, within the present year. Munde believes that 
localized fibro-sarcoma (the hard variety) is the more 
frequent. In this iny own experience is not in accord- 
ance with his. I believe sarcoma is not so very uncom- 
mon, but that it is often overlooked ; and it should al- 
ways be suspected in cases where we exclude fungosities 
and carcinoma. The symptoms of sarcoma may be very 
similar. Virchow (" Onkologie," vol. ii., p. 350) thinks 
many innocent hyperplasias of the mucous membrane are 
mistaken for sarcoma, but he gives no differential diag- 
nosis. In sarcoma scraping generally yields a consider- 
able quantity of soft, brain-like material, breaking down 
readily upon handling, homogeneous on section, fre- 
quently showing marked degeneration (pus, etc.). It 
never appears in distinct formations, but the fragments 
are always irregular in shape, whatever their size may be. 
The difference is marked, even to the naked eye, and is 
rendered very distinct by a lens of low power. 
Microscopically sarcomatous tissue is homogeneous in 
appearance, being entirely made up of round cells with a 
fine stroma. The cells are mostly somewhat larger than 
leucocytes and have a large central nucleus. Transi- 
tional forms, "alveolar sarcoma," "sarcoma carcinoma- 
todes," may be found in the uterus, the cells assuming 
an epithelial type, and being arranged in alveoli. These 
appearances are of course never seen in fungosities. In 
the examination of fresh and unstained specimens there 
is a liability of error, because in both cases the field is 
filled with masses of round cells. 
Differential Diagnosis. 
Symptoms. 
Little or no pain. 
Menorrhagia the rule, metrorrha- 
gia the exception. 
Discharge generally odorless. 
Fungosities. 
Considerable pain. 
Menorrhagia and metrorrhagia us- 
ual. 
Discharge often offensive. 
Sarcoma. 13 
Fungosities. 
Gross Appearances. 
Sarcoma. 
Pale pink color, semi-transparent, 
sometimes gelatinous. 
Distinct formations, of firm con- 
sistency ; undergo no degenera- 
tion. 
Grayish white, brain-like. 
Soft, friable, amorphous, and 
prone to degeneration. 
Microscopical Appearances. 
Single layer of normal columnar 
epithelium and irregular groups 
of leucocytes. 
Stroma considerable and not in- 
tercellular. 
Papillomatous arrangement. 
No infiltration of healthy tissue. 
Surrounding mucous membrane 
normal. 
Structure entirely cellular, single 
nuclei. 
Stroma slight and intercellular. 
No papillomatous arrangement. 
Healthy tissue invaded. 
Surrounding mucous membrane 
destroyed. 
Clinical differences between fungosities and sarcoma. 
-The thorough use of the curette in cases of fungosi- 
ties is followed by little or no hemorrhage. If the case 
is one of sarcoma, there is apt to be much bleeding for 
several days after the use of the curette, the condition of 
the patient is aggravated rather than improved, and 
there may be considerable pain lasting for several days. 
In case of simple fungosities, if they are thoroughly re- 
moved by the curette, and if the cause of the congestion 
of the mucous membrane be remedied, the patient is 
often permanently cured after a few months. In sarcoma 
similar treatment is of no avail whatever to arrest the 
tendency to hemorrhage, nor does the patient in the lat- 
ter case improve much under tonics, food, and general 
hygienic measures. Fungosities recur after six or eight 
months if the original cause remains, but for a period 
the patient is free from hemorrhage, and gains health rap- 
idly. Sarcoma recurs after removal, and after mere 
scraping with a blunt curette it often assumes a rapid 
growth. 
Treatment.-The disease having been recognized and 
a positive diagnosis made, the treatment of the existing 
condition-the fungosities-is very simple and satisfac- 
tory. The cure of the condition that gives rise to a hy- 
peraemic condition of the uterus is a very different and 14 
much more tedious affair, and must obviously be adapted 
to each individual case. 
• It is not usually necessary to dilate the canal of the 
cervix in order to use the curette. The presence of any 
growth or body within the uterus tends to cause a patu- 
lous condition of the cervical canal. The operation of 
curetting should be done under the influence of ether. 
The patient being on the side, a Sims speculum is intro- 
duced, and the canal of the uterus is cleansed by the 
use of cotton on the ordinary applicators. The whole 
surface of the uterus is then gently scraped with the 
blunt curette, the curve of the instrument being changed 
so as to enable every part of the cavity to be reached. 
Cotton should again be used to remove the loose fungosi- 
ties and to cleanse the uterus. An application of the 
strong tincture of iodine (Churchill's), or of strong car- 
bolic acid, should then be made tb the whole surface, a 
little absorbent cotton placed in the vagina, and the pa- 
tient put directly to bed, where she should remain for two 
days, or longer if there be any pain. 
The operation may be done without anaesthetics, but 
it is almost always painful, and it is not likely to be done 
so thoroughly. 
Apart from the effect of the curette on the growths in 
the cavity of the uterus, it has an excellent effect on the 
congested uterine mucous membrane, and has been re- 
commended as a means of cure. Diirelius, assistant to 
Martin, of Berlin, reports sixty cases of pregnancy, oc- 
curring in women who had been curetted-forty-nine of 
them for endometritis. 
Dr. Clinton Cushing, of San Francisco (Western Lan- 
cet, August, 1882, p. 340), recommends the blunt curette 
in the treatment of hemorrhage from congestion of the 
uterus, and considers it especially valuable in cases of 
hyperplasia of the body of the uterus, or subinvolution, its 
use in such cases being followed by marked improvement. 
Patients should be warned not to expect immediate 
improvement. The first period after curetting is often 
quite profuse, and it is not till the second or third that 
there is marked improvement. 15 
If done only in suitable cases, with due preparation, 
proper regard to cleanliness, and with antiseptic pre- 
cautions, and if the patient is put in bed immediately 
afterward, and kept quiet by morphine if there is much 
pain, I consider the operation of curetting little more 
hazardous than the passage of the uterine sound, which 
in certain fare cases has proved exceedingly dangerous. 
Contra-indications.-The curette is on no account to 
be used in case of recent pelvic inflammation or any 
degree of parametritis. Nor should it be used without 
thorough preparation in cases where the uterus is so 
sensitive that it will not tolerate the passage of the 
smallest probe. Such cases should be prepared by the 
abundant use of hot water, and should be watched very 
closely after the operation. 
The czirette.-A few words in conclusion as to the 
instrument known as the curette. 
Recamier's curette, though not described by him in his 
article on fungosities in 1850, was doubtless a cutting 
instrument. It was first a steel scoop, and afterward a 
loop of flat steel, sharpened on each side. It has recently 
been claimed in England that Recamier's instrument was 
blunt, but no evidence is given in support of the state- 
ment. Recamier speaks of it himself as the sonde curette^ 
and speaks of taking out with it a tablespoonful of fun- 
gosities. He refers to the operation as la cath'eterisme 
uterine. He speaks of having first used the curette, 
and then having applied the cautery, and also of hav- 
ing had unpleasant symptoms afterward. He reports 
the removal of a fibrous polypus by means of his instru- 
ment. The introduction of the curette met with much 
opposition, and Recamier seems inclined either to apolo- 
gize for it, or to stand on the defensive. 
Trousseau {Gazette des Hopiteaux, 1856) says the in- 
strument was so sharp that Recamier perforated the uterus 
with it on three occasions. 
Olshausen condemns Recamier's instrument as danger- 
ous, and recommends that of Sims; he speaks of Recamier 
as being very harsh in his methods.' 
Both Sims' and Simon's curettes were of steel, and 16 
had sharp cutting edges. About the year 1870 Dr. 
Thomas devised the blunt curette, and with slight modi- 
fications in shape that instrument has been very gener- 
ally adopted in this country. It has nothing in common 
with the sharp curette except the name. The name be- 
ing derived from the French verb curer, to cleanse, is 
more appropriate to this instrument than to one capa- 
ble of cutting. The introduction of this blunt curette 
has made the treatment of ordinary fungosities safe and 
simple. 
For general purposes the blunt curette should be of 
two sizes. The smaller one is an oval loop, one-fourth 
of an inch wide, outside measurement. This is used 
chiefly for diagnostic purposes. The larger one is three- 
eighths of an inch wide. Both are made of copper or 
soft metal, with a shank that can be adapted to the 
curve of the uterine canal, the entire handle being nine 
inches long. For obstetrical purposes they are made 
larger, and with much longer handles. Many modifica- 
tions of the blunt curette have been recommended, but 
the bluntness is the essential feature of Thomas' instru- 
ment, and so long as that is preserved the precise shape 
of the instrument is of little consequence, provided it 
will reach every portion of the uterine cavity without the 
use of force. Emmet's curette forceps is a different in- 
strument, and is intended to crush the fungosities without 
the possibility of danger to the healthy tissue. It was 
devised to avoid the evils sometimes consequent on even 
the most careful application of the sharp curette. Those 
dangers do not belong to the blunt curette, which, as has 
been said before, with proper care can do no more mis- 
chief than the passage of the sound. The therapeutic 
uses of the blunt curette were fully discussed by Dr. 
Munde in a paper published in the Edinburgh Medical 
Journal in 1878. A paper on the same subject was read 
by Dr. George T. Harrison before the New York State 
Medical Association, November 19, 1884, and published 
in the New York Medical Journal, December 20, 1884, 
and is, as far as I know, the latest addition to our 
scanty literature on this subject.