London. Published 1824, by Messrs. Longman, Hurst, Rees, Orme, Brown & Green.
In the usual manner of dissecting a side view of the pelvic viscera, an unnatural bearing is given to several important parts, by the following circumstances:—To assist the dissector a curved sound is previously introduced into the urethra, the consequence of which is, that the canal necessarily assumes whatever form the instrument may have. Views so taken are therefore incorrect, and give an erroneous idea of the natural course of the canal. The bladder and rectum are also excessively distended, the former being inflated to its utmost, and the latter filled with baked horse-hair. When the bladder is thus distended it rises out of the pelvis; and if in the dissection, the abdominal muscles have been turned aside, and the cellular connexions of the bladder much disturbed, its rise is so considerable as to elevate the prostate gland, and thus give a more horizontal bearing to the prostatic and membranous portions of the urethra. The distending the rectum also adds to the erroneous impression, by elevating the bladder, and thus bringing the base of the bladder, prostate gland and membranous urethra into a nearly horizontal line.
Such a view is calculated to give a correct anatomical idea of the course of the canal under retention of urine, and shews the propriety of using a catheter with the curve recommended by Sir Astley Cooper. The relative situation, however, of these parts is widely different when regarded in a lithotomic point of view.
In a person prepared for the operation the rectum is emptied by purgative medicine and an enema; and the bladder, which in a stone patient seldom contains more than eight ounces of urine, occupies the hollow of the flaccid or contracted rectum. Care has been taken not to distort these parts by the introduction of an instrument into the urethra, nor by more distention than was sufficient to preserve a general outline. To Mr. Giraud, dresser to Sir Astley Cooper, I am indebted for the drawings; the object of this plate being to represent the true bearing of the parts concerned in Lithotomy, they were drawn of the natural size, by measurement, from a young man, twenty-nine years of age, who died after six days illness; and the dissection being completed within twelve hours after his decease, the rigidity of death still remaining retained the parts in situ.
a. Section of the left os pubis.
b. Articular surface of the sacrum.
c. Section of the left crus penis.
d. Bulb of the penis.
e. Membranous portion of the urethra.
f. Prostate gland; its posterior edge concealed by veins.