[Reprinted from The American Journal op Obstetrics and Diseases op 
Women and Children, Vol. XL., No. 6, 1899.] 
A CURETTE FOR CERVICAL CANCER. 
HOWARD A. KELLY, M.D., 
Baltimore, Md. 
(With illustration.) 
No curette in my possession has proved perfectly satisfactory 
in the removal of the redundant carcinomatous tissue in cases 
of cancer of the cervix. As a rule, after a thorough curettage 
with any of the dull or sharp scoops, I still find that I can 
remove more tissue with the nails of my index and middle 
fingers. 
I have, therefore, devised the following curette, which serve s 
my purpose better, removing all available tissue with a mini- 
mum risk to the adjacent structures. The instrument may be 
described as made up of three parts, a large, stout handle 
affording a comfortable grasp for the entire hand, and a stout 
shank which tapers to a long and rather deep bowl. This 
bowl, which is the curette proper, is ovoid in form with a 
blunt margin, surrounded by crenations a little coarser than 
shown in the figure. 
I use the curette by grasping the handle firmly with the 
right hand, while the left index finger, introduced into the 
vagina, serves to control the crenated bowl, which is then 
vigorously employed to remove—that is to say, to tear away 
—the diseased tissues. The crenations, which form the essen- 
tial feature of the instrument, take hold of the tissue in a way no 
other blunt instrument will do, and if the force is exerted with 
good judgment there is no risk of thrusting the bowl beyond 
the limits of the disease. It is my practice to proceed quite 
rapidly in scooping out and breaking down the more superficial 
portions of the disease, and then to advance with greater cau- 
tion in the direction of the peritoneum, rectum, or bladder, 
repeatedly endeavoring to ascertain by means of the index 
finger the exact thickness of the tissues remaining in the 
septum. I t fi 1% a ijir 2 
kelly: a curette for cervical cancer. 
The only other instrument to which I am aware the curette 
bears the slightest resemblance is Thomas' spoon saw, used at 
one time by that eminent gynecologist in the enucleation of 
fibroid tumors; the resemblance here is, however, only superfi- 
cial, for the differences could scarcely be greater. The spoon 
saw is a shallower, broader instrument, with sharp recurved 
teeth; its margins are not sinuous or crenated as in my curette. 
The spoon saw, in other words, is a cutting instrument designed 
to work in sound tissues, while the curette is a tearing, scooping 
instrument for diseased cancerous tissues. 
The measurements of the larger instrument are as follows: 
total length, 25 centimetres; handle, 9| centimetres; shank, 
Hi centimetres; bowl, 4 centimetres. The width of the bowl 
is 17 millimetres, and the depth 14 millimetres. There are ten 
crenations, 2 millimetres in height and 2i millimetres in width 
at the base. The upper figure shows the size of the bowl of 
the larger curette; the lower figure gives the general appear- 
ance and proportions on a scale about one-third. The measure- 
ments of a smaller curette, which is sometimes used, are two- 
thirds those of the larger curette.