Catheterization enabled independence for thousands with spinal-cord injuries
I loved growing up in Philadelphia. It has an eclectic personality that makes the city like no other, and it has contributed immensely to American culture. With that said, aside from the ubiquitous cheesesteak sandwich, the next best thing to come from Philly is Benjamin Franklin.
Franklin deserves to appear on our $100 bill for myriad reasons. He was a printer, postmaster, ambassador, author, scientist and a Founding Father. However, much of his fame comes from his ability to solve common problems. He was like an 18th century MacGyver whose innovations and inventions have been on display in Philadelphia’s The Franklin Institute, which was created many years after his passing to promote interest in research and education.
As a young kid attending elementary school in the Philly suburbs, I enjoyed many field trips to The Franklin Institute. Exhibits changed often, but some of Franklin’s inventions, such as his bifocal glasses, a pair of swim fins and a lightning rod, were on permanent display. But there was one item that few visitors truly appreciate: Ben Franklin’s catheter (fi.edu/en/benjamin-franklin/inventions).
It looks more like a barbaric torturing device used during the Spanish Inquisition than a means to remedy a painfully distended bladder. Franklin was inspired to invent this “flexible urinary catheter” when he witnessed his brother John suffering from chronic bladder stones. Though catheters already existed at this time, Franklin’s catheter greatly enhanced the medical field. Instead of the typical catheter made out of animal skin, onion stalks and wood, or in some cases unbendable metal, Franklin invented a more tolerable catheter that was made of hinged tube segments. He commissioned a silversmith to manufacture his design and mailed it off to his brother with instructions and “best wishes.”
The next advancement was in 1836, when Louis Mercier’s coudé, or elbow catheter, eased some catheterizations with its tapered and curved tip. Then in 1844, Charles Goodyear obtained a patent for vulcanized, or moldable, hard rubber, which opened the door for mass production.
In 1935, Frederic E.B. Foley announced his rubber balloon catheter. Doctors finally had an indwelling device that could be held in place by its own configuration — not by bandages or tape.
Then World War II happened.
Prior to the war, most people with a spinal-cord injury (SCI) didn’t live very long, with life expectancy less than a few months. Up until then, catheters were only used for patients with short-term urological maladies, stones or in post-operation situations. With the advent of antibiotics and advancements in surgical techniques, people with traumatic SCI began living longer, which meant the practicality and tolerance of long-term indwelling catheters would be put to the test.
Following the war, there were at least 2,500 service members who had survived their traumatic injuries overseas and were transported back to Department of Defense hospitals in the United States. Sadly, chronic infections were common among this new population of catheter users, so urologists began to look at alternatives, including intermittent catheterization. With that in mind, as well as the advancements in rubber and plastic production, disposable intermittent catheters became an option but were not necessarily welcomed by medical professionals.
For decades, urologists were convinced that a sterile technique must be used during intermittent catheterization due to potential infections. However, in 1971, Jack Lapides, MD, introduced clean intermittent self-catheterization. This new technique persuaded urologists that germs introduced during the catheterization process were not the only cause of urinary tract infections and that stagnant urinary residuals also played a part in infections.
Lapides’ research proved that intermittent catheterization could be safer than an indwelling catheter and that a patient could routinely self-catheterize with a simple, clean approach and have no bacterial consequences. Thankfully, this method of catheterization liberated thousands of people with SCI, allowing them to live more independently.
Catheterization is one of civilization’s first therapeutic interventions, but this journey to present-day bladder management is a powerful example of how research and ingenuity can turn an ancient remedy into a modern mainstay.
In other words, the next time someone asks you why research is so important, show that person a picture of Ben Franklin’s catheter and see what that person says.
