Urethral Catheters: A Historical Review
Rabie E. Abdel-Halim*
Saudi Medical Journal 1990; 11 (2): 87-88
In the Graeco-Roman era and in the Middle Ages in Europe, S-shaped bronze catheters with one terminal eye were in common use. In the East, the evolution of urethral catheters started with the firm establishment of Moslem supremacy, and by 1013, straight or one-curve catheters made of gold, silver, copper, lead or salve of white lead with a rounded end and many side holes and a stylet were the standard instruments. Then in Europe in 1853 a prototype of the Foley catheter was designed. The next important evolutionary step was the rubber catheter of Nelaton in 1873.
Due to the frequent need to relieve an overfull bladder, the use of urethral catheters can be traced back to antiquity. A bronze S-shaped catheter with one terminal eye and size proportionate to age and sex1 was in common use since the Hippocratic period in Greece, or the days of Charaka and Susruta in India2 and up to the seventh century AD. 3
From the ninth to the fourteenth century in Europe the development of Graeco-Roman medicine came to an end and no progress was made in medical science. 2-6 Meanwhile, in the East with the firm establishment of Moslem supremacy, medicine along with other branches of knowledge were revived and acquired a scientific nature. 4,7,8 Under this influence, in the ninth century new catheters made of gold, silver and copper with only one curve to follow the normal curvature of the male urethra and a smooth rounded terminal end with many lateral holes were in use. 9 It had the advantages of resisting encrustation by urine10 and far fewer incidences of blockage. 9 Furthermore, a stylet in the lumen of the catheter was first thought of and used by Al Razi (841-926 AD) to save the patients the previous agonies of repeated catheterization due to blockage. 9
Then more malleable and subsequently safer catheters were made first from lead by AI Razi, 9 afterwards from the salve of white lead treated with ram blood to make it firmer so that it could be shaped, by Ibn Sina (980-1037 AD). 11 Also the tanned skin of some marine or wild animals was tried and the edges were joined by cheese or fish glue. 17 Meanwhile, the notion of a straight metal catheter was introduced and designed by AI-Zahrawi (Albucasis) (930-1013 AD). 12 According to AI Baghdady (1219 AD), 13 straight or curved metal catheters made of gold, silver, copper or salve of white lead were more popular than the leather ones as they were far smoother .
As the contributions of these scholars influenced the European mediaeval schools of medicine well into the eighteenth century, 2,4,12 the metal catheters mentioned above, whether straight or curved, remained as the standard instruments. 14,15 Then, as the nineteenth century in Europe opened a period of ingenuity on the part of surgeons and surgical instrument makers, 2,16 a prototype of the Foley catheter was designed. 17 This was followed by many modifications, the most important of which was the rubber catheter of Nelaton.18
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2- Desnos EC. The history of urology up to the latter half of the nineteenth century .In: Murphy LJT, ed. The history of urology. Springfield, Illinois: Charles C. Thomas, 1972: 30,69, 152-155.
3- Paulus Aegineta, The seven books of Paulus Aegineta. (Adams F, trans.) London: The Syndenham Society, 1846; 2: 351.
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9- Al-Razi, Abu Bakr Muhammad Ibn Zakariyya. Kitabul Hawi Fi-T Tibb (Rhazes Liber continens), Ist edn. The Bureau, Osmania Oriental Publications Hyderabad: Osmania University. 1961: 10; 164-166.
IO- Wangesteen OH, Wangesteen Sarah D. The rise of surgery from empiric craft to scientific discipline. Minneapolis: University of Minnesota Press, 1978: 91.
11- 1bn Sina, Abu Ali Al-Husain Ibn Abdullah. Kitab al-Qanun fit-tibb. (Avicenna Canon of Medicine) Beirut. Dar Sadir reprint of Bulaq edition. Cairo, 1877; 2: 522-523.
12- Albucasis, (Abu'I-Qasim Khalaf Ibn Abbas Al Zahrawy). Albucasis on surgery and instruments. A definitive edition of the Arabic text with English translation and commentary by Spink MS, Lewis JL, eds. London: Publications on the history of medicine. London: The Wellcome Institute, 1973: 403-405.
13- AI-Baghdady, Abu AI-Hassan Ali Ibn Ahmad Ibn Ali Ibn Hubal. Kitab AL-Mukhtarat Fil Tibb. The Bureau, Osmania Oriental Publications Hyderabad: Osmania University, 1943; 3: 435-436.
14- Parey, Ambrose. The works of that famous chirurgion Ambrose Paery, Translated out of Latine and compared with the French by Tho. Johnson. London: Printed by Richard Cotes and Willi Du-gard, 1649: 420.
15- Diderot D, d' Alembert, J Le R. Encyclopedie ou dictionnaire raisonne des sciences. Paris, 1751-1772, Anatomie Chirurgie. Faksimile-Oruck nach dem Originalen, bei Antiqua-Verlag, Lindau i.B. 1978: 2 & Fig. 1-6, plate X (Chirurgie).
16- Ellis HC. A history of bladder stone. Oxford: Blackwell Scientific Publications, 1969: 39.
17- Reybard JF. Traite pratique des retrecissements du canal de l'uretre. Paris: Labe, 1853: 397-399, 600, Fig. 13, Pl.2.
18- Nelaton A. In Desnos EC. The history of urology to the latter half of the nineteenth century (Murphy T, trans. & ed.) Springfield, Illinois: Charles C Thomas, 1972: 155.
* King Abdul-Aziz University Hospital, PO Box 6615, Jeddah 21452, Saudi Arabia
Rabie El-Said Abdel-Halim, FRCS Ed, Professor of Urology