The exploration of the urethra and bladder / by M. Tuchmann.

  • Tuchmann, M. (Maro)
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: The exploration of the urethra and bladder / by M. Tuchmann. Source: Wellcome Collection.

    19/108 (page 5)
    very often seen in man, but well developed in some animals, especially in the dog; arising on each side on the inner surface of ischio-pubic rami it terminates in two tendons which, before they unite with the tendons of the opposite side, leave room for the dorsal vein of the penis to pass through. The nature of these parts is better understood by what appears to be their real con- nection with the anterior layer of the triangular ligament: Holl, and other anatomists before him, assert it as a fact that the lower portion of the anterior layer ascends from below the inferior border of the M. trans versus prof, right up to and beyond the pubic angle, covering by such an extension the subpubic ligament behind it. I have gone a little more into details about the subpubic ligament because I have found that this ligament can be very distinctly felt on dead bodies and on living individuals, and may be used as a landmark in operations from the perinseum and in the introduction of catheters. If we pass the finger into the rectum, and push it vertically upwards towards the pubic symphysis, we can, at a distance of about two inches from the anterior border of the anus, touch the lower concave border of the subpubic ligament; in every case we perceive the strong resisting texture of this liga- ment, and immediately below it the soft tissue of the membranous urethra commencing its course into the cavity of the pelvis.* The straight and horizontal course which the membranous and prostatic urethra follow, and how nearly opposite the vesical orifice of the urethra lies to the point where the membranous part of the urethra passes below the subpubic ligament, we can make out on the dead body in the following way ; if on the dead body of an adult, with the pelvis quiet horizontal, we push a knife with the blade downwards straight through the skin of the perinaeum and through the underlying tissues, exactly below the subpubic liga- ment, holding the blade of the knife quite in the middle line, we reach the bladder through or very nearly through the vesical orifice of the urethra. Langer^ is quite right when he states that in the horizontal position of the subject the vesical orifice of the urethra corresponds to a plane which passes at a distance of one- half to one inch below the pubic angle, a distance which would be in accordance with the various lengths of the subpubic ligament. Jarjavay^^ has come to the same conclusion. Undoubtedly, the vesical orifice of the urethra appears in some cases on an higher level than the inferior border of the subpubic ligament, and the membranous and prostatic urethra take a more ascending course into the cavity of the pelvis. This, I submit, is almost entirely caused by a greater inclination of the pelvis. Langer and Dittel assume that, besides the pelvic inclination, it is sometimes a large quantity of fat accumulated in the pelvis which keeps the vesical orifice in a more elevated position. I do not * I may mention here, and this may perhaps confirm my statement with regard to the possibility of finding out the subpubic ligament, that according to Quain^, the base of the triangular ligament may be felt through the rectum. If the base of the triangular ligament which is less thick and resistent can be found out, then I must affirm that the lower border of the subpubic ligament is more easily felt.