The exploration of the urethra and bladder / by M. Tuchmann.

  • Tuchmann, M. (Maro)
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: The exploration of the urethra and bladder / by M. Tuchmann. Source: Wellcome Collection.

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    know whether this can be accepted as proved, and the fat amassed in the higher pelvic region may counterbalance the effect produced by the fat below. Moreover, I have not in stout dead bodies observed a greater quantity of fat just round the prostate. Nor can I admit that the form of the prostate during health greatly alters the position of the urethral orifice. It is true that the volume and weight of the prostate vary in different subjects, but it may be questioned whether at the same time its form varies in such a way that the position of the vesical orifice is thereby much altered. Other factors influencing the position of that orifice besides those which I have just mentioned have to be taken into consid- eration, viz., the various length of the subpubic ligament and, in living subjects, the strength and the tonic contraction of the muscles which support the prostate. How, then, can we get an idea of the form and curve of the urethra ? An ordinary metal catheter held with its shaft in the vertical position and the great curve forward, the long beak being hori- zontal, reproduces in a pretty accurate way the form and curve of the urethra, the prostatic and membranous parts corresponding to the beak ; the scrotal and the pendulous part (this latter being brought into a vertical position) corresponding to the shaft. Testut^* has lucidly described the whole urethra as representing in its form two straight hnes united by a curve of various degree. I imagine that the surgeon of the medical school of Alexandria who, about 2000 years ago, invented that very ingenious instru- ment, the catheter, started with the knowledge in mechanics that two arches of the same curve most easily glide over each other, and then modelled his instrument on the shape of the urethra, with the several parts of which he had made himself thoroughly acquainted. Whether his catheter was quite like that of our own times is not of much importance ; the length of the beak and the form of the curve need not be the same in all these instruments. On the contrary, it would be wrong to think that our ordinary catheter could fit everybody, and all attempts to construct such a universal instrument have proved futile. It has been well said that there are almost as many different urethrae as there are individuals, and the successful introduction of the catheter does not depend so much on its form as on the hand that guides it and on the anatomical knowledge of the surgeon.