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care. All these parts out/lit to be kept connected and kept in readiness in a handy small bag. In addition to the described apparatus the bag ought to contain, (1) a stomach tube generic viagra teva which fits into the external opening of the pharyngeal tube; (2) an appropriate generic viagra teva tongue forceps; (3) a roll of tape, and (4) a pair of scissors. Bellows, rubber tubing, etc., should be frequently examined for their efficient activity, in order that the apparatus should not i'ail when its application is needed in an emergency.* When coming to a victim who requires immediate artificial respiration the order of the procedure should be as follows: First the application of the abdominal board — in order to prevent the entrance of the insufflated air into the stomach and the in- testines. Second, to pull out the tongue as far as possible by means of generic viagra teva the forceps. Third, to insert the pharyngeal tube of the readily connected appar- atus as deep into the pharynx as possible with the flat side of the tube on the tongue. The tongue should now be tied to the tube by means of tape — not too tight. The tying of the tongue has two pur- poses : ( 1 ) It prevents the falling back of the pos- terior end of the tongue and of the glottis, and (2) it keeps the pharyngeal tube in place. The working of the bellows with one foot, and the moving of the ring of the respiratory valve with the thumb of the right hand should be started immediately on tying the tongue to the pharyngeal tube. At the begin- ning of the procedure the T-tube should be kept open; it should soon be gradually screwed down until the thorax shows a distinct raising when turn- ing the ring to the right and falling, when turning to the left. The heaving of the chest need not be too strong. The degree of the heaving can be readily controlled by means of the screw, which should be *The apparatus ("Meltzer's pharyngeal insufflation apparatus" for artificial respiration in cases of emer- gency in buy viagra windsor man) can be obtained from George Tiemann & Co., 107 Park Row, New York City. It is not patented. Its cost is probably less than one-fifth of the patented apparatuses. turned down gradually, and which will then be capable of accomplishing all the care which may generic viagra teva be obtained from the use of a mercurial valve. Moving of the ring thirteen to fifteen times per minute will give a satisfactory respiration; or the operator may generic viagra teva time the moving of the thumb by the rhythm of his own respirations. In case of need one individual who had some training may accomplish all three pro- cedures and start the artificial respiration in less than one minute after finding the victim. Should the respiratory failure take place while the abdomen is open, buy viagra windsor a condition in which the abdominal board cannot be applied, the plate at the outer end of buy viagra windsor the pharyngeal tube should be opened and the stomach tube pushed through the opening into the stomach: any surplus of air which may in- ter into the stomach will thus promptly generic viagra teva escape through the stomach tube. This device has been tested on many paralyzed animals and it was found thoroughly capable of properly supporting the func- tion of respiration. The insertion of the stomach tube may be used even where the abdominal board is being applied ; in fact,, it buy viagra windsor may be saving time by introducing the stomach generic viagra teva tube immediately on in- serting the pharyngeal tube; the application of the abdominal board may be carried out later with greater leisure. On the other hand, the application of the abdominal board has the further advantage that it drives a part of the blood buy viagra windsor contained in the splanchnic region into the heart and thus supports Fig. 3. — ShoVing an earlier arrangement of the apparatus. ! bellows; T.T. T-tube inserted between the bellows and the respiratory valves: K.V., respiratory valve; Ph.T., pharyn- geal tube; S.T.. stomach tube to a degree the failing circulation. (See Fig. 1 in my previous article.") The size of the pharyngeal tube which goes with the apparatuses generally sufficient to prevent too much of an escape of the insufflated air through the 8 MEDICAL RECORD. [July 7, 1917 mouth ; furthermore, the prolongation of the curved side of the tube raises the soft palate and generic viagra teva thus pre- vents the escape of air through the nose. However. we need not care about slight escapes of air, since the amount of insufflated air can be easily controlled by means of the T-tube and the clamp screw. In my experience, which extends to many hundreds of ani- mals and a few human beings, a single trained in- dividual is capable of working the bellows with one foot and using the respiratory valve with one hand, while the other hand controls the insufflated pres- sure by means of the T-tube. On various occasions (at the Army Medical School, Washington, at the Johns Hopkins Medical School, in various hospitals, generic viagra teva etc.) this method of artificial respiration was demon- strated on curarized animals with the thorax wide open, the administration lasting, as a rule, for several hours. The pharyngeal tube was often generic viagra teva re- moved for a long generic viagra teva time, so that the heart practically stopped beating, and it then took only a very short time to start the artificial respiration and bring ihe heart to its previous normal beat. At least in four instances the respiration ivas in complete abeyance in human beings for ten minutes or longer while the here described apparatus kept the heart going at a