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The extremely simple modification of this same tool, which some five years ago it occurred to me to apply to blad- der work, and which I have repeatedly shown to classes ever since, I should not have thought of publishing, it being only a very old idea with a new application, had not Dr. Keen's simplified form of Mr. Cath- viagra sale toronto cart's drain- age seemed to me not so simple as my own modification of dentist's drainage. By reference to the accompanying sketch, it will be seen that the essential arts are only a fountain syringe and several feet of additional small rub- ber tubing. A is the clamp which viagra sale toronto comes with every fountain syringe. It has been removed from the end and snapped upon the side of the tube, so as almost to close it, permitting Mow only drop by drop. ? is the joint between the two pieces of rubber tubing. That going to the bladder is preferably rather smaller in calibre than the other. The simplest way, if one has a glass, metal, or vulcanite T-tube, is to use that to make the con- nection. But if not, the joint is made as follows: Cut out a circle from the side of the exit tube from the bag. Sew the end of the other tube to the edges of this small hole. Make tight with rubber cement (made by dissolving gutta-percha tissue in chloroform to saturation). Strengthen by wrapping with narrow strips of rubber adhesive plaster. C is a trap which is absolutely essential. It is not of the usual shape of the traps to which, under sinks, we are accustomed; but upon reflection it will be seen that it is still a trap, and made in the simplest way, so as to be self-retaining. Either as a knot (as in viagra sildenafil discount the sketch) or held in a circle by snapping on an elastic band, the exit tube is thus made into a small trap: and viagra sildenafil discount the smaller the better. A circle three inches across is large en. nigh. We must not permit additional traps, by bends in viagra sale toronto the exit tubing from the reservoir at any other point. D viagra sildenafil discount is a small piece of glass tubing, say a couple of inches long. Now as viagra sildenafil discount to the working of this drainage device: From the reservoir the water trickles down until the trap becomes filled. viagra sale toronto As soon as overfilled, it siphons off viagra sildenafil discount with a little rush. This in turn makes a partial vacuum above the trap and the urine in the bladder is drawn up to fill this vacuum. Thus a second siphon is created, the fluid running freely from the bladder until it is empty. This process of intermittent siphonage repeats itself at regular intervals of any desired frequency. As viagra sildenafil discount a rule, if the flow from the reservoir be no faster than from one to two drops per second, this will suffice to prevent a bladder from overfilling. And at this rate of viagra sildenafil discount flow, it is not necessary to replenish the bag of the fountain syringe oftener than once in several hours. It makes no difference in the working whether the bag be hung above the patient or lower. As a rule (though this is not essential), I run a large size of soft catheter to the bottom of the bladder through the suprapubic wound. This catheter, like a stomach- tube, should have two openings below; say a second eye cut opposite the original one. Thus, there cannot be obstruction from sucking in a fold of mucous mem- brane. The catheter is used because its walls are thicker than those of ordinary rubber drainage tubing, and hence the catheter is less likely to viagra sildenafil discount become flattened if accidentally flexed sharply at the wound or else- viagra sildenafil discount where. Where it escapes from the bladder, pin its side with a safety pin to the dressings. Connect it with the siphon apparatus by a piece of glass tubing at D. Should we wish to wash out the bladder, this is easily clone without disturbing the wound. Take off the clamp, A, and pinch it on again tightly at E. Now the contents of the fountain syringe will run freely into the bladder. Cease pinching at E, and the fluid will run as vigorously by siphonage out of the bladder and into the bucket below. Sometimes it is desirable viagra sildenafil discount to know the exact amount and the appearance of urine drained away; also we may wish to analyze that urine undiluted by fluid from the reset voir. To permit this, I insert in a break at any point in the tube leading to the bladder a wash bottle with its usual equipment of tight-fitting rubber stopper and two glass tubes. In conclusion, it hardly seems necessary to dis- cuss other methods of automatic suprapubic bladder drainage. As every surgeon knows to his annoyance, these are not reliable. But in the simple plan just described, if carried out as detailed, the profession will find something that can be depended upon. It ought, I think, viagra sildenafil discount to do away in great measure with the neces- sity for a double cystotomy the lower or perineal of which is made for drainage purposes only. A brief description of this device I published in the Annals of Surgery for April. Philadelphia County Medical Society At the