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the amount of toxemia in the individual. This dose is repeated at intervals of every four to seven days. The dosage is gradually increased by twenty-five million each lime until tlie Order Cialis Online With Mastercard maximum of 200 or 300 million bacteria is reached. Relief of symptoms is not usually obtained until three doses have been given. Occasionally quick resi)onse is seen, and in most uncomplicated cases three months of treatment give permanent relief. In those patients who have a relapse, quick re- sponse to vaccine injections is usually seen. In very obstinate cases it may be necessary to continue Ihe vaccine treatment for a year or more. A reac- tion after tiie injection of the vaccine usually occurs. This consists of a local Order Cialis Online With Mastercard redness, the size of a fifty cent piece, pain and swelling at the Order Cialis Online With Mastercard site. In a se- vere reaction this swelling spreads until the whole upper arm is involved. This local reaction begins in six to eight hours and lasts twenty-four to sev- enty-two hours. At the same time a general reac- tion takes jjlace. A brief description of this Order Cialis Online With Mastercard is that liierc is an exaggeration of all the symptoms: head- ache, malaise, vertigo, and occasionally nausea. A decided increase in the severity of neuralgic or niyalgic ])ains, and of pain, soreness or discomfort in the abdomen, if these symjitoms h.ad been pres- ent. This reaction is followed by decided relief of all the previous toxic symptoms. In markedly toxic cases, if an active colon organism from the diseased part of the colon has been obtained, early reactions are severe. The reactions have usually been severe in most cases in which excessive doses, such as 300 to 1,000 million bacilli, have been ad- ministered. In those cases in which no reaction Order Cialis Online With Mastercard is obtained the cause may be (a) attenuation of the organism from which the vaccine has been luade ; (b) pre- vious immunization of the [>aticnt, as after pro- longed dosage of vaccine; (c) mild degrees of tox- emia, or (d) alisence of colon bacillus toxemia in the body. In the last stated cause, by elimination the vaccine becomes of value in diagnosis. In no case of profound intestinal toxemia, as yet, has Order Cialis Online With Mastercard there been a complete absence of reaction following the administration of the vaccine. The converse also holds good, that in no case in which a sharp local and general reaction has taken ])lacc could we ex- clude chronic intestinal toxemia. Loose bowels antl intestinal evacuation have oc- curred in quite a few instances, following the vac- cine injections, and improvement continued. For the diagnostic value of local reactions following vaccine injections, I refer to Noble P. Rarnes (8"). The following classification for tiie use of auto- genous colon vaccines has been suggested bv the author's success in the vaccine therapy : mild chronic toxemias which do not respond to diet ; all severe chronic toxemias ; operative cases, before and after operation ; doubtful cases, as an aid to differential diagnoses. It is essential to make a thorough study of every case, which includes a radiographic gastrointestinal investigation. Symptomatology is very important, but we should not take any one's word or personal opinion about the state of his bowels. In numerous instances "absolutely regular bowels" are proved to have large residues. It seems pretty certain to the writer that all patients with chronic intestinal tox- emia have had a constipation at some time, and that this is a very strong etiologic factor, and also that the laxative habit does not cure, but rather ag- gravates the toxemia. To prove this we find many "residual cecums," "sigmoids," etc., in patients who have regulated bowels by taking catliartics or laxa- tives regidarly. But these patients have symptoms of toxemia, which are frequently not recognized. Nature often finds its own best relief, so we hear often that "the Order Cialis Online With Mastercard osteopath has g;iven me most help, but Order Cialis Online With Mastercard has not cured me." On account of the predomi- nance of nervous and mental symptoms, these people frequently consult the neurologist, who, if thor- oughly u]) to date, should recognize the trouble and institute proper diagnosis and treatment. There are undoubtedly many cases of primary nervous system lesions in which the gastrointestinal toxemia is sec- ondary. There is every reason that these patients should have the proper care of the toxemia, even if it is a secondary complaint. The insane asy- lums claim their share of chronic intestinal toxe- mias. As example, three of the patients under con- sideration for this pa|)er had been declared insane, and are now well. One patient, an old lady of seventy-six, with the diagnosis of senile dementia, had the mental symptoms cleared up for weeks at a time by means of dietetic measures and autoge- nous colon vaccines, with remarkable and lastinc; results. The nature of this presentation, and lack of time, make it inadvisable to give any detailed case his- tories. A detailed analysis of sixty-four cases has already been published in the Journal of the Amcr- icatt Medical Association. December 9, 191 6. Since that time there has been no reason to believe this method of therapy a failure. 1 would like to describe one case (o), that of t patient who had intestinal toxemia for years, with profound depression amounting to insanity for two years. The urine was saturated with indican, and she was mentally incompetent The colon wa< kinked and diseased. Developmental reconstruction of the colon was Order Cialis Online With Mastercard done by Lynch and Draper, but the mental condition became worse, with delirium and coma, severe albuminuria with all kinds of casts, and for a week she was expected to die hourly. Autogenous colon vaccines were given, followed by very Order Cialis Online With Mastercard severe reactions, increased delirium, restless- ness, and the patient had to be restrained to the bed. These reactions lasted for from eight to twelve hours, followed by a pericwl of calm and generr.I improvement, and a diminution of the indican an I albumen and casts. \'accincs were administerc.l every four days for a month and a half, when they 974 CORNWALL: SOME ASPECTS OF SYMPTOMATIC TREATMENT.