OCR Text |
Show 2'22 rs raonucnon of THE CATHETER. INTRODUCTION or Inn CATHETER. that the instrument comes into the position of the dotted line The question naturally arises, why is this turn given to the catheter, if the point is to remain precisely where it was? If this method of introducing the catheter had originally any meaning, further than to make a shew of dexterity, it was surely this, that the turn of the handle might give motion also to the point, so as to overcome the diflicult turn of the urethra. Le Dran gave us the injunction of studying to attain a correspondence betwixt the left hand, which holds the penis, and the right, which holds the catheter: he taught too, that B; still the point remains. C, is the position of the catheter when it is drawn up towards the pubis, when it is to be moved directly onward in the course of the dotted line, until it enters the neck of the bladder. D, is another point at which the ca~ theter is sometimes obstructed. See next plate. The catheter must be withdrawn for about a quarter of an inch, and the whole catheter drawn closer up to the arch of the os pubis, and then carried forward. In this way, it will seldom fail to enter. What I mean is perhaps to be better understood from the plan, where A is the catheter obstructed, while C is in outline the catheter, in a higher W" ' , has been observed, that the motion given to the penis cannot reach the point at which the obstruction occurs. It will, however, be found, that by pressing the finger in the pressing it, as in B, often does not succeed. perineum, and thus drawing the integuments forward, the course of the catheter is facilitated. But still more will it be possible to smooth the passage of the catheter, and direct its course, if the finger be introduced into the rectum. This last practice is in a peculiar manner necessary, when the difficulty proceeds from enlargement of the prostate gland. The finger in the rectum informs us of the place, and of~ But both ways There is a manner of introducing the catheter, which I should have mentioned only with ridicule, had I not seen W‘- "MW" It elevation, in which it is to be carried forward; while de~ will of course be tried. h"\\"\m the penis should be drawn upward upon the catheter. 2'23 it practised in London, by men to whom the profession looks up with great. respect. I mean the introduction of the ins strument with the convex side upward. In objection to the practice, I would offer these remarks :- 1. Obstructions to the passing of the catheter, both in a na~ tural and in a diseased state of the canal, are more generally on the lower than in the upper side; and this way of intr0< .ducing the catheter, with its point turned downward, expos- cs it to the obstruction of every irregularity. 2. But I believe that, in general, no bad effect results from this manoeuvre; for the point of the catheter does not commonly reach the ' obstruction until it is brought round to that position which it would have had, if introduced in the simple, and I am happy to say the common method. 3. In the description of this operation, it is expressly enjoined, that while we take a large sweep with the catheter, not suddenly but slowly, we must be careful to keep the point steady, and make it the centre of the whole motion ; for it may otherwise take a ten of the cause, of the obstruction. It enables us more freely to depress the hand, and elevate the point of the ca- theter, so as to direct it over the irregular swelling of the prostate gland, if, as it has happened, the urethra. be dis: torted and compressed by it. If, for example, the gland be enlarged chiefly on the low or parts (which I believe it generally is), then the urethra is raised up and elevated beyond the usual level, and the can theter, striking at F, is obstructed. ' Suppose that there is a section of the pelvis and bladder-- A, is the os pubis. B, the rectum. C, part of the distended bladder. D, the enlarged prostate gland. E, the catheter, with the point hitting on the fore-part of the prev tate gland, at F. new direction, different from that which it followed before. G, the catheter depressed: but still it does no! error vmm musty" . |