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llclv) ii(nbfntion.s, ^U, RKCIvNT IMI'liOVKMENTS IN URETilHO.^COIMC AI'I'AltATIS.* Ih WiM.iAM K. Otis, .M. I). SiNCK the invention of tiio generic for flomax original urethroscope by Uozzini, ol Frankfort, in 1805, what is flomax insiinicienl illumination has been the obstacle toward the obviation of which the principal inodificationH of this in- Htrument have been directed. It is only recently, flomax price however, that this diniculty has been entirely overcomo by the introduction of the electric light, and we now have an illumination of the urethroscoi)ic fiehl which is all flomax cost that can be desired. This advance has been largely due to the efTorts of Josef Leiter, of Vienna, who has designed an instrument simple in construction, light anil easily handled, inexpensive, and with tlie perfect illumination ob- tained by reflected flomax in women electric light. During all this time, from the invention of the original flomax tamsulosin illuminating apparatus, little if any change has been made in iiretliroscopic tubes, though they have been constructed of various materials and borne vari- ous names. Glass, from its transparency, seemed especially adapted to this purpose, but, owing to the reflections from its surface flomax for women and the changes produced by pressure on the mucous membrane, it is without practical value. The discovery in 187i> of the great underestimation of flomax women the normal urethral caliber permitted the use of much larger tubes, with a corre- sponding increase in the size of the field ; but the urethroscopic tube remained, and still remains, a simple straight tube. Within the past year an ingenious instrument has been devised by von Antal, of Buda-Pesth, by means of which the urethra is seen dis- tended with air. As the field is not greatly increased, and as an assist- ant is necessary, to flomax prices make pressure in the rectum, thus preventing the entrance of air into the bladder, and as no applications can be made through this instrument, its practical use will probably be limited. My own attempts to overcome some of the minor difficulties of urethroscopy have been directed, first, to avoiding the price of flomax constant swab- bing necessary, particularly when discharge or bleeding is present. To effect this, I have placed a small tube along the side of the urethro- scopic tube to within an eighth of an inch of its lower end (Fig. 1). This tube pierces the urethroscopic tube at its upper end at a right * Read before the Surgical Section of the New York Academy of Medicine, November 12, 1888. April 13, 1889.] MISCELLANY. 419 angle, and ends in a socket. The sraall size of tlie inner tube prevent any practical interference with the size of the field. By attaching a small rubber bulb, which fits by a socket or sliding joint to the upper end of the small tube, pressure on the bulb (which is filled with fluid) covers the field with fluid, and a relaxation of the bulb alternative to flomax sucks it per- fectly dry, this being repeated until the field i.s seen to be washed clean. By substituting a hypodermatic syringe for the bulb, a graduated amount flomax 0.4 mg of a medicated solution may generic of flomax be placed with exactness on a cleansed surface. By this means the field is always under observation, which is not the case when the applications are made with the swab. The deep urethra is frequently the seat flomax alternative of pathological changes which seem particularly adapted to treatment by means of the urethro- scope, but, owing to the pain and discomfort to the patient occasioned by the passage of a straight instrument, and the inconvenience experi- enced by the surgeon in obtaining a satisfactory examination, also on account of the position of the instrument, a neglect of a visual inspec- tion of this portion of the canal often results. To overcome this difii- culty I have devised a tube having a curve on the lower end correspond- ing to that of the ordinary sound (Fig. 2). Upon withdrawing the obturator, a mirror fastened to a wire is slid down into the angle and a very excellent image of the end of the tube obtained. As it cost of flomax often hap- pens that the mirror (if cold when first introduced) becomes clouded by the moisture of flomax cr the urethra, it is well to warm it over a lamp, or wipe it over with a little glycerin, before introducing it. Obturators constructed of rigid materials of necessity possess one of two faults. Either flomax generic the edge of the tube is so thick that it forms a ridge about the end of the obturator, or, this ridge being removed to render the instrument perfect of introduction, the edges of the tube are left too sharp when the obturator is removed. Either of these condi- tions, while perhaps of not great flomax 0.4 importance in the examination of com- paratively healthy urethra^ nevertheless often cause pain and, what is more important as regards the success of the examination, bleeding. I have had constructed an obturator (Fig. 3) which consists of a hard-rubber flomax online shaft with a cross-bar (6) at the upper end, to prevent its slipping through the urethroscopic tube. Through this shaft runs a steel rod having a smooth hard-rubber tip {d) firmly fastened to its lower end, which loosely fits the urethroscopic tube. Between the tip and the hard-rubber shaft about half an inch of soft rubber is inserted

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