URINE. 



Urethra is unobllruAed, and tlie iiiflrument can be intro- 

 duced without refinance ; and, fecondly, when there exifts 

 an impediment to its intr»duftion. As the hiftory of thefe 

 obftacles cannot be feparated from that of the caufes of the 

 diforder, we fhall follow Default, and now only take into 

 confideration the operation of introducing the catheter when 

 the urethra is pervious. What ougiit to be the conduft of 

 the furgeon under other circumftanceB will be noticed 

 hereafter. 



With refpeft to catheters, three things are to be confi- 

 dered : l, the inilrumcnt itfelf ; 2, the manner of intro- 

 ducing it ; and, 3, the line of conduft to be purfued after 

 its introduftion. 



Catheters were anciently compofed of copper : Celfus 

 knew of no other kind. As thefe, however, had the incon- 

 venience of becoming incrufted with verdigreafe, they at 

 length fell into difufe, and others, made of filver, were fub- 

 ftituted for them. This change had been made as early as the 

 time of the Arabian praftitioners, and it lUll receives the 

 approbation of the bell modern fnrgeons. 



Catheters vary confiderably in their length. For an adult 

 female fubjeft, they fiiould be about fix inches long ; and 

 for young girls, four or five. For grown-up men, the length 

 ought to be about ten inches and a half; an'9 for male chil- 

 dren and boys, fix or eight inches. Thefe are the ordinary 

 lengths. There is alfo much diverfity in the fize or thick- 

 nefs of the inftrument. For a woman, the diameter ought 

 to be about two lines ; and for young girls, a line and a 

 half. For male adult fubjefts. Default recommends the 

 thicknefs of two lines and one-third ; and for boys, that of a 

 Lne and a half. In general, whenever the urethra is per- 

 vious, it is better to follow the advice of Default, and em- 

 ploy a largifh catheter, wliich will enter the paflage more 

 eafily, not get entangled in the folds of the membranous 

 lining of tlie canal, and afford a more ready outlet for the 

 urine. On the other hand, fmall catheters fliould be pre- 

 ferred, when there are obllruitions and indurations in the 

 paffage. 



Catheters alfo ditfer in rtiape. Thofe which Default ufed 

 had only a flight curvature of one-tiiird of their length ; a 

 curvature which began infenfibly from their llraight part, 

 and continued to their beaks inclufively. The curvature was 

 alfo regular, fo as to form the fegment of a circle fix inches 

 in diameter. The female catheter, however, had only a flight 

 curvature towards its beak ; a fiiape wliich is adapted to the 

 direftion of the meatus urinarius. Default alfo improved 

 filver catheters, by caufing them to be made with elliptical 

 openings at the fides of the beak, with rounded edges, in- 

 ftead of the longitudinal flits, which were previoufly con- 

 (Irufted. The inconvenience of thefe flits had been acknow- 

 ledged by every practitioner in furgery ; the lining of the 

 urethra haring been frequently entangled in them, pinched 

 and lacerated, whicii produced acute pain, and fomctimes 

 profufe hemorrhage. With a view of preventing thefe 

 evils, Default alfo was careful to fill the elliptical openings 

 with lard, wliich could not fall into the hollow of the cathe- 

 ter, as an elaftic gum bougie was patfed into the cavity of 

 th)l inftrument, in order to hinder the occurrence, and was 

 not withdrawn before the end of the catheter was aAually in 

 the bladder. See QEuvres Chir. de Default, t. iii. p. iiS, 

 &c. 



Befides filver, or inflexible catheters, furgeons now fre- 

 quently employ flexible catheters, made of elallic gum. 

 Thefe laft inllruments, indeed, are of fo much importance, 

 tliat they may be faid to conftitute one of the greatell im- 

 provements in modern furgery. They are flateil to have 

 been originally invented by a Frenchman of ihc name of 



Bernard. Imperfcft attempts, however, li»d been made by 

 others, at an earlier period,io invent catheters poffeffiiig the 

 property of flexibility. Van Helmont propofed the ufe of 

 catheters made of iiorn ; but this fubflance was found to be 

 too fliff, and to become very quickly incrulled with depo- 

 fitions from the urine. Fabricius ab Aquapendente recom- 

 mended the employment of flexible catheters made of 

 leather ; but thefe were objeftionable, as they were very 

 foon foftened by the urine and mucus of the urethra, fo that 

 they flirivelled up, and were rendered impervious. There 

 were alfo other flexible catheters, formerly tried, which were 

 compofed of fpiral fprings of filver wire, covered, with the 

 fliins of particular animals. Thefe laft were found to fpoil 

 very quickly, in confequence of putrefaAion ; and when left 

 in the urethra any time, the beak was fometimes entirely fe- 

 parated from the reft of the inftrument, and left behind. 



The elaftic gum catheters now in ufe are liable to none of 

 the preceding inconveniences. They are formed of filk 

 tubes exprefsly woven for the purpofe, and covered with 

 a coat of elaftic gum. They are fufficiently flexible to 

 accommodate themfelves to the different curvatures of the 

 urethra ; they arc not foftened by the urine, and they con- 

 ftantly remain with their cavity unobliterated. Their fmooth 

 and pohfhed furface makes them continue a long while free 

 from incruftations of the urine. Sometimes they are intro- 

 duced without a ftilet or wire, which is paftcd into their 

 canal, for the purpofe of giving them a certain curvature, 

 and greater degree of firmnefs. This plan is adopted when 

 the catheter will not pafs with the ftilet ; but, in general, 

 the ftilet is employed and withdrawn as foon as the tube is in 

 the bladder. 



There are two methods of introducing a catheter ; viz. 

 with the concavity turned towards the abdomen ; or, on the 

 other hand, with the concavity of the inftrument turned 

 downwards in the firft ftage of the operation. The latter 

 plan of courfe requires the inftrument to be turned as foon as 

 its beak has arrived in the perineum ; and, confequently, the 

 French furgeons diftinguifh this method by the name of the 

 " tour de maitre." The operation of introducing a cathe- 

 ter, or catheterifm, as it is fometimes termed, may be prac- 

 tifcd either when tlie patient is fitting up or lying down : 

 the laft pofitioii, however, is accounted the moft favourable. 

 When tlie catiicter is introduced, with its concavity turned 

 upward, and the patient is in the recumbent pofture, the 

 thighs are to be feparated, and the legs moderately bent. 

 The furgeon is to draw back the prepuce, and to hold the 

 penis between the thumb and fore-finger of his left hand, 

 which are to be applied on each fide of the corona glandis, 

 and not at all to the under furface of the penis ; as this would 

 prefs upon the urethra, and obftruA the entrance of the ca- 

 theter. The handle of the inftrument being now held pa- 

 rallel to the axis of the body, its beak is to be introduced 

 into the urethra. While the penis is extended and drawn 

 forward, as it were, over the catheter, the latter inftrument 

 is to be gently puflied on, until its beak has .irrived as far as 

 the arch of the pubes. At this particular moment, tlie handle 

 is to be depicfled towards the patient's thighs, and the ma- 

 noeuvre, well managed, generally at once directs the end of 

 the catheter, through tlie prollatic portion of the urethra, 

 into the cavity of the bladder. 



When the catheter is to be introduced with its concavity 

 turned downwards, or by the " tour de maitre," the beak 

 of it is to be palled into the urethra, and the penis drawn 

 forwards over it, as it were, jull as in the foregoing method. 

 As foon, however, as the end of the catheter has reached 

 the point at which the canal begins to form a curve under 

 the pubes, the furgeon is to make the penis and the inftru- 

 ment 



