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Drawings from Bourgery & Jacob
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Catheters are used to drain the bladder via the urinary tract.
Sounds are used to dilate the urinary tract which can be blocked due to
infection, prostate swelling, or trauma. The drawing to the left
(click to enlarge) shows various situations where a hollow catheter or
solid sound is inserted via the urethra. These tubes allow for
drainage of the bladder.
Various forms of urinary tract
catheters are shown in pre-Civil War catalogs by Snowden & Brother and
post-Civil War catalogs by Tiemann & Co. and Gemrig. Frequently
we find catheters are missing for both pocket cases and full surgical cases.
Why is anyone's guess, but the empty formed spaces in a case are testimony
to their being missing.
Shown below are pages from
Snowden's pre-War catalog in 1860, Gemrig from the 1870's, and Tiemann's
1880's catalog. The metal catheters on this page are silver and rigid, not
flexible. This is the type most often found in large Civil War era
wood cased surgical sets in the lower sections of the case, under the
removable tray. Also shown below are soft flexible catheters
made in France and sold by Tiemann and other makers.
There were no major supplier
catalogs published during the Civil War. The post-War catalog evidence
I have of this kind of urinary tract instrument is from the late 1860's (Gemrig),
and 70's, 80's Tiemann catalogs, which may indicate advances in design
during the War, but most likely represents the same type of instruments used
during the Civil War.
Click on all images to enlarge
Catheters shown in
Henry Smith's 1852
book on surgery
Catheters from Snowden & Brother
catalog, c. 1860
Snowden & Brother's pre-War
catalogue below shows they were importers of French gum catheters
Catheters, sounds, bogies, from
Tiemann & Co. catalog, c. 1880's (examples at bottom of page)
Catheters from Gemrig's catalog
c. late 1860's
Male catheters and sounds from Civil
War military field sets in this collection
Catheters and sounds from a
Tiemann
Civil War field set
Catheters and sounds from a
Tiemann Civil War military urology set
Catheter and sounds from a
Snowden and Brother Civil War military set
Above: c. 1870 (67
Chatham) Tiemann ivory set with later marked handled sounds (4
in top of photo) and (above left) a Tiemann sounds gauge for
determination of the diameter of various sizes of sounds, like
those in the ivory set.
Below is a collection of Geo.
Tiemann catheters both hard and soft. Both Snowden and Brother, as
well as Tiemann imported French soft catheters and those are included.
Some of the soft catheters have ivory tips. Some of these examples are
exactly like those described above in the Tiemann catalog.
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A page from an 1851 book
on urinary diseases by
S. Gross, M.D., which show similar gum catheters.
This information is
significant because we see use of gum catheters during the Civil
War, but most are no longer in the sets because of use or over 125
years, they melt and fuse together.
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Rigid silver catheters for draining
the bladder after dilation with a urethral sound
Silver catheters with loops for
attaching a string to hold them in place
Three examples of catheter
use reported during the Civil War from the History of Surgical and
Medical Records
Reasons for rejection
of Army applicants:
(32) Incontinence
of urine, being a disease frequently feigned and of rare occurrence, is not
of itself a cause for exemption. Stone in the bladder, ascertained by the
introduction of the metallic catheter, is a positive disqualification.
Medical cases cited
in the Medical and Surgical History:
CAMPBELL,
HARRISON G., Private of Co. F, 5th United States Cavalry, aged 25 years, was
wounded in action near Louisa Court House, Virginia, on May 4th, 1863, and
fell into the hands of the enemy. He was exchanged, and sent to Annapolis on
the hospital transport State of Maine, and was admitted to the general
hospital at that place on May 17th, with two suppurating sabre wounds of the
scalp, one over the right parietal eminence, the other behind the left ear.
He had headache, with frequent pulse, constipated bowels, and appeared to be
very feeble. He was purged, and then ordered good diets and." whiskey and
quinine freely." On May 20th erysipelas attacked the left leg, which had
received no injury. Tincture of iodine locally and tincture of the
sesquichloride of iron internally were employed to combat this complication.
On May 21st there was epistaxis; the pulse was small, at 110; the tongue
heavily coated. On the 23d there was diarrhoea, which was controlled by
pills of opium and camphor. The next day the pulse had risen to 120, and was
soft. The abdomen was tympanitic. Stimulants were freely given. The
catheter
was resorted to, on account of retention of urine, which was scanty and high
colored, and oil of turpentine, in doses of ten drops, thrice daily, was
ordered. On the 28th the erysipelatous inflammation had extended up the back
and over the right leg. The teeth were covered with sores. Turpentine, with
carbonate of ammonia and whiskey and concentrated nutriment, and tincture of
iodine locally, constituted the treatment. On June 6th, the erysipelas had
extended to the face and throat, and the patient became delirious. He
continued in an unconscious state until June 14th, 1863, when he died.
Acting Assistant Surgeon J. M. Matlock, who reports the case, ascribes the
fatal event to "exhaustion following typhoid erysipelas," and as unconnected
with the scalp wounds, which maintained an healthy appearance to the last.
CASE.--Lieutenant
Colonel Cornelius W. Tolles, chief quartermaster Middle Military Division,
was attacked on the 11th of October, 1864, by a band of guerillas as he was
passing through Newtown, Virginia, on his way to the front. Although he
surrendered without resistance, one of the treacherous party, stepping
behind the Colonel, shot him in the head. The missile, a pistol ball,
penetrated the cranial cavity through the occipital bone at a point midway
between the superior angle and the curved line, three-fourths of an inch to
the left of the median line, making a clean perforation and lodging in the
posterior lobe of the cerebrum one-half inch deep. He was conveyed to
Winchester, and placed under the care of Dr. Emanuel, Acting Staff Surgeon
U.S.A.
This officer
states that the wound suppurated well, and caused no pain; the patient's
mental faculties remained unimpaired, and his appetite good, so that a
favorable prognosis was granted. On October 22d, the ball was extracted in
small fragments. About the end of October, evacuations of the faeces and
urine began to occur involuntarily; on the 31st, there was an entire
suppression of the urine, as ascertained by the introduction of the
catheter,
and the faeces were again discharged involuntarily. On the 4th of November,
the vision and hearing became defective. Delirium ensued, and death occurred
on November 7th, 1864. Upon removing the calvaria, at the autopsy, the dura
mater around the wound was found ecchymosed, and the cavity in the cerebrum,
which was about one-half inch deep, filled with purulent and offensive pus,
and lined with plastic filamentous fibrin. A fragment of bone, about
three-fourths of an inch in diameter, was extracted from a point just below.
The pia mater had suffered morbid changes. A sero-purulent fluid was found
in the inferior and posterior depressions of the lateral ventricles, and
likewise in the fourth ventricle, the lining membrane of which cavity had
undergone softening, as had also the sheaths of the roots of the seventh,
eighth, and ninth pairs of nerves, which were of a greenish hue; the optic
commissure was congested. The substance of the encephalon was sound
throughout. The semi-lunar lobe of the left lateral hemisphere of the
cerebellum was firmly adherent to the tentorium. The case is reported by
Acting Assistant Surgeon W. L.
Hammond.
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