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cases. In order to apply this ])rincii)le, where nece.s- sary, Generic Cialis 2.5 Mg Online to cases of venereal di.sea.se in the communica- ble stage, who cither cannot or will not provide for themselves adequate treatment and supervision, so that their neighbors and fellow citizens may be ade- quately protected, the Department of Health has now nearing com(>lction and about ready for occu- pancy and use a small building for venereal dis- eases on North P.rothcr Island, capable of receiving sixty patients, men and women. The medical staff is already appointed, individuals infected with syphilis and gonorrhea have been taken through the police power and the Board of Health, and held for treatment until no longer in a communicable stage of tlie disease. Ju.st as cases of irres]ionsiblo. home- less, ignorant, or vicious Generic Cialis 2.5 Mg Online pulmonary tuberculosis have, for many years past and to an increasing de- gree, been removed from lodging houses or crowded tenements, to Riverside Hospital, so, in the future, the same tvpe of venereal di.sease cases will be re- moved and held as a danger to the public. This will still leave a large responsibility for the other hos- pitals of the city, where, at present, there is a shame- fully inadequate provision for the patient with gonorrhea or syphilis, man or woman, or child, who should, from the point of view of the physician, be treated with the same consideration and the same efhcient care as patients suffering from other dis- eases, which are not supposed to carry the same stigma of immoral conduct with them. It is not for the physician to judge his patient's immorality. His business is to prevent, relieve, treat, and, where pos- .sible, ciire disease, and in accomplishing these ends it is obligatory upon him to play his part as associate with the officers of the Department of Health in carrying into effect the various laws and regulations above described. With such cooperation as has, at all times, been given, to my personal knowledge, to the Deparunent of Health, within these past four years, by the members and officers of your Generic Cialis 2.5 Mg Online society, and in particular by the physicians who have made the Brooklyn Dispensary a Mecca for all students of the venereal disease dispensary problem, we should accomplish a reduction in the duration of the communicable stage of .syphilis and gonorrhea and I)revention Generic Cialis 2.5 Mg Online of many of the i)ermanent disabilities which now crowd our chronic hospitals and asylums. VACCINE THEKvVPY IN CHRONIC INTES- TINAL TOXEMIA.* By G. Reese Satterlee, M. D., New York. The diagnosis of specific bacterial infections of the intestinal tract from bacterial findings in the feces is often very unsatisfactory for the reason that the presence or absence of Generic Cialis 2.5 Mg Online specific bacteria arc often of no diagnostic import. The common in- fections of the intestine are tuberculosis, typhoid, bacillary dysentery, syphilis, diphtheria, staphylo- Generic Cialis 2.5 Mg Online coccus and streptococcus infections, amebic dysen- tery and colon bacillus infections. Among the rarer conditions arc actinomycosis, bacilltis acrogenes capsulatus and pneumococcus infections and the I)lague. A few of these can be positively identified by microscopical findings, but, in many of them, tiie mere presence Generic Cialis 2.5 Mg Online of the organisms in the feces is 11 f no real value. (Quantitative tests for the com- mon bacteria in the stools, except perhaps in chil- dren, seem also to be of no real value. Among the different theories of the causation of chrome intestinal toxemia, the bacterial theory .<:eems 10 me to be the most attractive and tangible. If not the sole factor, it is at least a verj' important one. We must from the start make a distinction between jiutrefaction of intestinal contents and the other slower and more insidious condition, called, for want of a better term, chronic intestinal toxemia. We cannot prove the nature of it any more than we can explain that of uremia or eclampsia, but we can probably fall back upon Generic Cialis 2.5 Mg Online two main factors, epithelial cells and bacteria, with a Generic Cialis 2.5 Mg Online contributing clement of chemical changes in the contents of the gut it.self. Our modern conception of chronic intestinal tox- emia is that of a chronic diffuse toxemia of intestinal origin, the result of aberrant biochemical conditions, usually, but by no means always, bearing a measur- able ratio to the delay in the onward passage of tho •Prr.irntcd twforr the MrHical Aiuocialion of Ibe Gmlrr Ciw oi" New York. Dcctnibcr 17. 1917. 972 SATTERLEE: CHRONIC INTESTINAL TOXEMIA. [New York Medical Journal. intestinal contents as visualized by the Roentgen ray (Lynch. Draper, Satterlee) (,i). The colon bacillus has its normal habitat in the large bowel, where it probably plays an important part in the end of digestion. Researches (2) Generic Cialis 2.5 Mg Online show that the colon bacilli elaborate materials which exert marked inhibitory influences on the putrefactive bac- teria in the intestine, particularly the Bacillus putri- ficiis coli, and in this way prevent the origin of in- testinal autointoxication. Carbohydrate oxidation and fat decomposition; fermentation, not putridity, are caused by the B. coli action. Under normal conditions it lives a saprophytic existence and is not only harmless but beneficial to the host. We will see, therefore, that it is probably for this reason that results from sterilization of the intestinal tract have no lasting effect on the intestinal toxemia wlien the toxemia is thoroughly rooted in the system. When the colon is diseased, however, the colon bacillus is distinctly harmful, either in the walls of the colon or when lodged in other parts of the body, as the peritoneum, genitourinary or respiratory tract, etc. It is tlien capable of becoming pyogenic and its intracellular poison is set free and can then act on the body of the host. Vaughan (3) says the bac- terial cell must die to liberate the poison. Deaver (4) states that the B. coli isolated from the intestine in