It is occasionally, in cases of cancer of the prostate, of service to adopt this proceeding to prevent the eye of the catheter from getting blocked before the bladder is entered, but it is strange that Galen should have fallen into the mistake of thinking that it is necessary to set up a syphon action, as he was well aware of the expulsive power possessed by the bladder; in fact, his explanation of the physiology of urination is almost up to date.
Celsus gives a good description of the catheter both male and female (VII. xxvi):
Res vero interdum cogit emoliri manu urinam, quum illa non redditur, aut quia senectute iter eius collapsum est, aut quia calculus vel concretum aliquid ex sanguine intus se opposuit: ac mediocris quoque inflammatio saepe eam reddi naturaliter prohibet. Idque non in viris tantummodo, sed in feminis quoque interdum necessarium est. Ergo aeneae fistulae fiunt; quae ut omni corpori ampliori minorique sufficiant, ad mares tres, ad feminas duae medico habendae sunt; ex virilibus maxima decem et quinque digitorum, media duodecim, minima novem, ex muliebribus maior novem, minor sex. Incurvas vero esse eas paulum, sed magis viriles, oportet, laevesque admodum; ac neque nimis plenas neque nimis tenues.
There are fine specimens of the catheter, both male and female, in the Naples Museum. The male catheter is from the ‘House of the Physician’ in Pompeii. It is 24 cm. in length and is about the size of a No. 11 English. It has two gentle curves, so that it closely resembles the instrument reintroduced by Petit in the eighteenth century. See [Pl. XLV, fig. 1]. A catheter of similar shape, but broken in three pieces, was found by some workmen at Baden in the Seventies. They were given by Dr. Wagner, of Baden, to Mr. Atkinson, M.P., London, and are possibly now in some English collection (Brunner, op. cit. p. 42).
In the excavation of the Roman Military Hospital at Baden, 1893, a fragment of a catheter was found, and is now in the possession of M. Kellersberger. It consists of the curved part of a catheter, and it is 13 cm. long and about the size of a No. 10 English. The curve is considerably greater than that of the Naples specimen (Un Hôpital Militaire Romain, planche ix).
The female catheter in the Naples Museum is 0·98 m. long, and of the same diameter as the male one. It is straight ([Pl. XLV, fig. 2]).
Bladder Sounds.
Had the ancients solid bladder sounds? They must have been well aware of the characteristic grating sensation conveyed to the skilled hand on striking a stone with a metal instrument, for we have several references in the classics to the manœuvre of pushing back, by means of a catheter, a stone impacted in the urethra. Rufus of Ephesus (Περὶ λιθιώσης κύστεως) says of impacted urethral calculus: ‘Those that are stuck fast push back with the catheter if you prefer not to do lithotomy’ (ἐρείδοντας οὖν εἰ μὴ θέλοις τέμνειν ἀπῶσαι τῷ αὐλίσκῳ). Soranus (II. xviii) says if a stone is the cause of dystocia we must push it out of the neck of the bladder into the bladder with a catheter (καθετήρ). The word Rufus uses puts it beyond doubt that a hollow tube is meant, or we might have argued that καθετήρ did not necessarily mean a hollow tube, since Hippocrates uses it in the sense of a uterine plug (ii. 830). Yet strange to say, the sensation conveyed to the hand and ear on striking a stone with a metal instrument is nowhere definitely given as a cardinal symptom by a classical writer.
Rufus describes the symptoms of vesical calculus at length and finishes with instructions for searching the bladder. The word he uses (μήλωσις) at first sight seems to indicate that this was done with a sound, but it turns out to be bimanual rectal examination only which he describes. The use of the sound as a staff in lithotomy, or as a dilator of a strictured urethra, was not known to the ancients, and thus we have no evidence from the literature that a solid bougie existed. Some instruments have come down to us, however, which seem undoubted solid bladder sounds. There are three sounds of bronze in the Naples Museum, which have the identical appearance of our modern bladder sounds. It might be argued that these have not quite the shape of the catheter described by the ancients, but there is an instrument in the Mainz Museum against which even this objection cannot be brought. It is a solid sound of the double curvature described by Celsus, and is identical in shape with the catheter from the Pompeian surgeon’s house ([Pl. XLV, fig. 3]).
Lithotomy Scoop.