A manual of syphilis and the venereal diseases, . unding of the urethra. tides are dropped and the fingers of the left hand areplaced on the perineum, where they give support to thelower wall of the urethra and keep the point of the in-strument well against the upper wall. Up to this timethe handle of the sound has been held constantly closeto the abdominal wall. The handle should now belifted and gently carried toward the feet, thus describ-ing an arc of a circle exactly in the median line of thebody. When the handle of the sound has reached andpassed the perpendicular (Fig. 38), the left han
A manual of syphilis and the venereal diseases, . unding of the urethra. tides are dropped and the fingers of the left hand areplaced on the perineum, where they give support to thelower wall of the urethra and keep the point of the in-strument well against the upper wall. Up to this timethe handle of the sound has been held constantly closeto the abdominal wall. The handle should now belifted and gently carried toward the feet, thus describ-ing an arc of a circle exactly in the median line of thebody. When the handle of the sound has reached andpassed the perpendicular (Fig. 38), the left hand leavesthe perineum and supports the handle of the sound, ORGANIC STRICTURE OF THE URETHRA. 529 while the right hand presses upon the pubes and re-laxes the triangular ligament, allowing the sound by-its own weight to slip through the membranous andprostatic portions of the urethra into the bladder (). That the sound has entered the bladder may bedemonstrated by partially rotating the handle, showingthat the tip of the instrument is Fig. 39.—Sounding of the urethra. To remove the sound the handle is carried throughmotions exactly the reverse of those pursued during itsintroduction. Neither force nor traction is necessary. Force is required for the introduction of a sound inexceptional cases only, and should never be used by anybut the expert. The sound should be held lightly be-tween the tips of the thumb and the fingers, as a firmergrasp would interfere with the sense of touch, which isof great importance, and would increase the danger ofunconsciously using force. It should never be forgottenthat the sound is a lever of the first class, the tip form-ing its short and the handle its long arm, and that thepressure produced by the point upon the urethral wallis many times greater than that exerted by the hand ofthe operator upon the handle. Even in a normal urethra 34 530 SYPHILIS AND THE VENEREAL DISEASES. the progress of the sound may be arrested by urethralspas
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