Fernand Cathelin (1873-1960): Eminent urologist and pioneer of sacral anaesthesia

Fernand Léon Cathelin (Fig. 1) was born on the 27th of May 1873 in Longjumeau, Seine-et-Oise, France, and died on the 31st March 1960 at the age of 86 in his place of birth. After medical studies and clinical work in different surgical fields, he was trained in urology under Félix Guyon (1831-1920) and his assistants Joaquin Albarran (1860-1912) and Félix Legueu (1863-1939) and finally became “Chef de clinique des voies urinaires á la Faculté de Paris” (senior resident in charge of education of the trainees) at the Hôpital Necker in Paris in 1904. 

After Albarran had taken over the direction of the urological unit, Cathelin left Necker in 1906 and opened his own private urological service in Paris with a policlinic at the Avenue de Suffren, located next to the Hôpital Necker, and his own hospital at the Rue Vercingetorix, the “Nouvel Hôpital d’Urologie de Paris”, which was built in 1907. (Fig. 2) 

Cathelin had a good income from treating his private urological patients but would also see poor patients for a special low fee or even for free. This urological activity was conducted independently from the other established hospitals in Paris and for several reasons led to controversies between Cathelin and some of his colleagues and the “Association Française d’Urologie” (AFU).

Pierre Leger has analysed this dispute in his historical review of French urology and pointed out that many hospital and university doctors in Paris were jealous of Cathelin who was extremely successful in his work, but never had to compete for the position of a hospital chief. Cathelin in contrast was very direct and even crude in his response to these accusations. 

Gabriel Louis Angoulvant (1872-1932), French colonial administrator, gave this impressive portrait Cathelin’s personality: “A fighter with a harsh tongue, overflowing with activity, as fast as a motor, disdainful of vain worldly conventions... a brain always at work, a bold surgeon, always innovative, a breaker of idols, having made considerable progress in his art, a philanthropist who devoted the greater part of what he earned to creating this admirable hospital where so many poor people found free relief from their ailments.”1

Cathelin was a very active clinical surgeon and provided several surgical and technical contributions to urology. Among the urological instruments he devised was a new “diviseur vésical” introduced in 1902 for separating the urine from both upper urinary tracts.2 At the tip of the blind transurethral instrument a metal loop was opened that separated the two sides of the bladder through a rubber membrane and allowed separate collection of the urine from the right and left upper urinary tract. (Fig. 3) Although these techniques were soon abandoned, it was famous enough in its time to depict it in the caricature of Fernand Cathelin in the famous journal Chanteclair (Fig. 4) and to make a play on words with the political term “diviser pour régner” (divide and rule) with the word “rein” (kidney). 

Another instrument was the “cystoscope à air” for air cystoscopy from 1905, which was at that time a widely-used technique, especially among gynaecologists.3 The endoscope was introduced with a mandrin (Fig. 5, m) and the bladder examined through an obturateur oculaire (Fig. 5, o). Air was introduced through a syringe and the urine evacuated over a funnel at the lower side of the instrument. A second model was equipped with two tubes for ureteric sounds (Fig. 5, s.u.). Figure 6 shows the examination conducted with this air cystoscope in a male patient including a portrait of Cathelin as the endoscopist.

Cathelin published about 300 articles and several books, e.g. Atlas d’anatomie pathologique chirurgicale urinaire (1909), Les méthodes modernes d’exploration chirurgicale de l’appareil urinaire (1909), Manuel pratique de la lithotritie (1911), Cinq années de pratique et d’enseignement à l’hôpital d’urologie (1913) or L’infection gonococcique et ses complications. (1928). 

Cathelin’s surgical experience during World War I when serving as a medical Major and chief of a “Centre d’urologie” in Orléans was summarised in his book Chirurgie urinaire de guerre from 1919.4 (Fig. 7) Cathelin gave a detailed description on 300 pages of trauma mechanisms of modern war injuries of the urogenital tract and outlined the treatment options including numerous case reports. Moreover, he addressed a new method for the evacuation of wounded soldiers from the battle fields of Verdun and transportation to the specialised hospital unit in Orléans. (Fig. 8)

Cathelin’s most important contribution to urology, anaesthesia and medicine in general is the sacral approach for epidural injections. (Fig. 9) Working independently of one another in Paris, Cathelin and the neurologist J. Athanese Sicard (1872-1929) presented this technique of local cocaine injection in April 1901 at the “Société de Biologie” in Paris. In January 1901 Cathelin had performed the first animal experiments with epidural injections at the laboratory of Prof. Richet and injection of 1% cocaine in four patients undergoing hernial repair under the guidance of Prof. Lejar with imperfect results.

Cathelin did not only suggest the technique for regional anaesthesia in surgery but also for pain relief in cystitis, urethritis, prostate cancer and other tumours as well as for the treatment of urinary incontinence, impotence and nocturnal pollutions. In 1902 he finished his “thése inaugurale” entitled “Les injections épidurales par ponction du canal sacré et leurs application dans les maladies des voies urinaires” which he dedicated to his teacher Prof. Guyon and which was published as an extended book in 1903.5 (Fig. 10) 

The German translation of this thesis from the same year inspired the German gynaecologist Walter Stoeckel (1871-1961) to adopt and popularise the technique for regional anaesthesia in obstetrics in 1909. Cathelin himself kept occupied with the technique over the next decades and still commented on the recent developments of the epidural injections in 1934.6

Cathelin had a keen interest in medical ethics and philosophy and collected many writings in his book Autour de la chirurgie from 1931, starting with an article on “La conscience du chirurgien”.7  The book addressed different aspects of surgery mainly from a philosophical and historical point of view. It starts with essays on World War I, followed by “Chroniques mélanges”, necrologs and portraits of living persons.

His further interest in the history of medicine is documented by articles he published on Christophe Colomb et les médicins. Le rôle des médicins dans la découverte de l’Amérique in 1933 (Paris, Hippocrate, 1933) and on “Les maladies d’Ambroise Paré” (Progrès méd, Supp; May 14, 1938; pp 33-37).

Beyond medicine Cathelin was also an expert in ornithology and he published several books in this field: Les migrations des oiseaux in 1920, Le nid de l’oiseau in 1924, and 15 conférences sur l'oiseau, son rôle, sa protection in 1928. In the last book he even addressed the consequences for bird life on the battle fields of  France during World War I. Cathelin was a member of the “Société nationale d’acclimatation de France”, Société zoologique” and “Ligue pour la Protection des oiseaux”. He was also “Officier de la Légion d’Honneur”. 

His contacts with other experts in these fields is documented for example through the hand-written dedication of his book Autour de la Chirurgie to Prof. Marcellin Boule (1861-1942), director of the “Institut de Paléontologie humaine” in Paris. (Fig. 11)

Cathelin finally acquired a historic building in his hometown Longjumeau, the formerly called “Hôtel du Dauphin” (Fig. 12) which had been redesigned several times. The facade was renovated in the 19th century but the buildings of the courtyard go back to the 15th century. It was in this house that on 23rd March 1568 the Peace of Longjumeau was signed, ending the Second War of Religion between France’s Catholics and Protestants. Cathelin established a museum, the “Musée d'Histoire Naturelle”, in this building with 14 rooms, including two laboratories, and a museum of animal, plant and mineral folklore. The inauguration of the museum was held on 8th July 1934.

The museum was later re-inaugurated as the “Musée Cathelin” in 1997 and still exhibits minerals, animals, herbal plants and ancient farm tools from the collections that belonged to Cathelin. Furthermore, artefacts from Ancient Greece, Rome and Egypt are exhibited, which were donated by Frédéric and Berthe Nathanson.

On 31 March, 1960 Fernand Cathelin died in this historic home at the age of 86 years and was buried in Longjumeau cemetery. One of the main roads of the city, the “Boulevard du Dr. Cathelin”, still reminds us of his memory today. A biography on Fernand Cathelin was published in 1994, entitled: Une personnalité Longjumelloise. Le docteur Cathelin (1873-1960) Urologue, muséologue et écrivain.8

1. Leger, P. Chronique de l’urologie française. Schering, 2000.
2. Cathelin, F. Le cloisonnement vesical et la division des urines. Baillière, Paris, 1903
3. Cathelin, F. “Nouvelle méthode de cystoscopie: cystoscopie à air et à vision directe sans partie optique avec lampe renversée, au plafond.” Annales de Maladies des Organes Génito-Urinaires 1905; 23: 1245-60.
4. Cathelin, F. Chirurgie urinaire de guerre. Baillière, Paris, 1919
5. Cathelin, F. Les injections épidurales par ponction du canal sacré et leurs applications dans les maladies des voies urinaires. Baillière, Paris, 1903
6. Cathelin, F. “La bonne et la mauvaise technique des injections épidurales.” Le prôgres médicale, 1934; 14: 593
7. Cathelin, F. Autour de la chirurgie. Baillière, Paris, 1931.
8. Bautrait, M.J. Une personnalité Longjumelloise. Le docteur Cathelin (1873-1960) Urologue, muséologue et écrivain. Université populaire, 1994