A manual of syphilis and the venereal diseases, . ruments whichmay thus be conducted through the stricture. Thesebougies are dangerous, as the caps may become looseand the filiform bougie may be left in the stricture or inthe bladder; besides, they offer no advantage over eitherof the two preceding methods. Whalebone bougies fre-quently become cracked, rough, or frayed as a result ofkeeping and handling; consequently it is necessary toinspect each bougie (as should be done with all soft in-struments) just before using, to make sure that it is soundand smooth. Tunnelled sounds and catheters (Fi
A manual of syphilis and the venereal diseases, . ruments whichmay thus be conducted through the stricture. Thesebougies are dangerous, as the caps may become looseand the filiform bougie may be left in the stricture or inthe bladder; besides, they offer no advantage over eitherof the two preceding methods. Whalebone bougies fre-quently become cracked, rough, or frayed as a result ofkeeping and handling; consequently it is necessary toinspect each bougie (as should be done with all soft in-struments) just before using, to make sure that it is soundand smooth. Tunnelled sounds and catheters (Fig. 49) are so madethat they can be threaded over a filiform bougie andthus be guided safely into the bladder. They shouldhave a short curve, and the short tunnel should be largeenough to allow the guide to slip through it easily, withedges smooth and rounded to prevent cutting the use the tunnelled sound safely and to advantage, atleast five or six inches of a long filiform bougie shouldbe passed into the bladder. The tunnelled sound is. Fig. 49.—Gouleys catheter-staff (Tiemann). then threaded over the guide and slipped down to thepoint of the stricture. Here it is gently pressed forward 538 SYPHILIS AND THE VENEREAL DISEASES. through the stricture as the guide is slowly and gentlydrawn out. If the guide becomes fast in the larger in-strument, both guide and sound should be withdrawnuntil the former is again freely movable. Failure toobserve these precautions may result in a false passageor in cutting the guide in two and leaving one end of itin the stricture. Introduction of Flexible Instruments.—In the use ofsoft and flexible instruments slight pressure or force isallowable, though some of the rubber bougies are stiffenough to do damage if carelessly used. The positionof the penis during the introduction of flexible instru-ments is not a matter of great importance except for thesmall-sized instruments, for which the penis should beheld parallel with the thighs an
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