924 
sibility of rendering the urethra straight by 
simple traction of the penis. 
he true suspensory ligament is calculated 
by its position and strength to prevent the 
surgeon from depressing the penis sufficiently 
to straighten the urethra, and in the dead sub- 
ject no force so applied, short of what suffices 
to tear the ligament in question and to rupture 
partially the attachment of the crura penis to 
the bones, can efface the curvature of the pos- 
terior segment of the canal, but if the suspen- 
sory ligament be divided by the knife, and if 
at the same time the crura penis be detached 
ever so little from the pubis, the slightest trac- 
tion exercised subsequently upon the penis 
renders the urethra perfectly straight. The 
writer by no means intends to deny that cathe- 
terism by straight instruments is a feasible 
operation: to straighten the urethra by drawing 
the penis in certain directions, and without any 
other aid, is one thing, and to introduce a 
Straight instrument into the bladder along the 
urethra is a totally different matter; to accom- 
plish the former, either in the living or the 
dead subject, so long as the true suspensory 
ligament is uninjured and the crura penis re- 
tain their attachments, will be found absolutely 
impossible, whilst the latter operation may 
very generally be performed by any surgeon 
who possesses ordinary dexterity. The princi- 
ple on which the introduction of straight in- 
struments is effected admits of ready explana- 
tion. By raising the penis as before described 
the operator renders the urethra, from the 
glans to the buib inclusive, perfectly straight, 
and therefore the staff traverses the passage 
so far without impediment, but any attempt 
to force it farther in the same direction would 
rupture the lower wall of the urethra, and pro- 
pel the point of the instrument towards the 
rectum. The hinder portion of the canal leads 
upwards and backwards to the bladder, and it 
therefore remains to be explained how a straight 
instrument, occupying the spongy part of the 
urethra, and with its point directed downwards 
and backwards towards the rectum, can have 
its course so changed as to pass upwards and 
backwards to the bladder. The solution of the 
problem is easy: the handle of the instrument 
is first drawn forwards so as to form a right 
angle with the pubis, and then depressed until 
it becomes nearly parallel with the patient’s 
thighs, whilst at the same time an onward 
movement is communicated to it, whereby the 
OF glides upwards and backwards into the 
ladder. In these movements the staff ob- 
viously represents a lever of the first order, the 
fulcrum formed by the lower wall of the ure- 
thra opposite to the true suspensory ligament of 
the penis, and the beak of the instrument 
being elevated as its handle is depressed. 
In addition to its curvature, that part of 
the urethra which belongs to the perineum pre- 
sents other features of interest to the surgical 
anatomist. In the dead subject its diameter is 
naturally far from uniform, whilst in the living 
its calibre is exceedingly liable to vary, accord- 
ing to the contraction or relaxation of the 
PERINEUM. 
_of which is directed forwards, whilst on eith 
muscular expansions which in certain situations 
invest it. Its parietes also exhibit in man 
places peculiarities of organisation calcu 
to embarrass the surgeon, and therefore some 
further notice of this part of the canal becomes 
here necessary. . ; 
The prostatic portion of the urethra is an 
inch and a quarter or at most an inch and a half 
in length. In the adult it takes an obli 
direction from above and behind down 
and forwards; but in the aged subject it rum: 
more horizontally, a change produced the 
developement of the “ bas fond” of the bladder; 
and in the child its course is nearly vertical in 
consequence of the position of the bladder at t 
period of life. The prostatic urethra is slight 
contracted at each extremity, whilst in the in- 
termediate space it is somewhat widened, the 
dilatation being most observable near its Ic 
wall. The verumontanum or caput gallina 
ginis, a prominent fold of mucous membrane 
extends in the middle line along the floor 6 
this part of the canal: it exhibits anteriorly 
depression named the sinus pocularis, the ori 
side the aperture of the common ejaculator 
duct usually opens. The verumontanum — 
placed between two deep depressions calle 
the prostatic sinuses ; these contain numero’ 
orifices of the prostatic ducts, a few only bei 
observable on the upper wall of the urethi 
At the posterior extremity of each sinus 
transverse fold of mucous membrane, of wi 
the free concave margin looks forwards, mi 
be occasionally observed; this has been ¢ 
the “ pyloric valve” by M. Amussat; t 
the majority of subjects no such structure ex 
and when present it is generally occasioned 
an incipient enlargement of the third lobe 
the prostate gland, which, projecting upws 
from below, elevates the mucous membra 
at either side, so as to produce the 
arrangement in question. 
From this brief exposition it follows 
many impediments to catheterism may be 
countered in the prostatic portion of the u 
The ducts which open upon its walls 
their orifices mostly directed forwards, 
sometimes morbidly enlarged, when they m 
easily arrest the point of a fine bougie; 
the prostatic sinuses forming depressions be 
the level of the floor of the urethra 
folds of mucous membrane just describe 
also calculated at times to entangle a si 
sized instrument. Most of these impedim 
are situated along the floor of the urethra, 
from their very nature they are likely to ob: 
none but the smallest instruments. To 
them, therefore, the surgeon should if pos 
select an instrument of large size and d 
the point along the upper wall of the pas 
The difficulties of catheterism are some’ 
vastly increased by disease of the prostate g 
but obstructions of that description are bey 
the scope of this article. emarka 
sympathy so constantly observed in pract 
between the testicle and the urethra is explail 
by the manner in which the lining men 
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