316 Suppuration 



Coley's Mixture. The clinical observation that occasional 

 accidental erysipelatous infection of malignant tumors is followed 

 by sloughing and the subsequent disappearance of the tumor, 

 suggested the experimental inoculation of such tumors with Strep- 

 tococcus erysipelatis as a therapeutic measure. The danger of the 

 remedy, however, caused many to refrain from its use, for when one 

 inoculates the living erysipelas virus into the tissues it is impossible 

 to estimate the exact amount of disturbance that will follow. 



To overcome this difficulty Coley* has recommended that the 

 toxin instead of the living coccus be used for injection. 



A virulent culture of the streptococcus is obtained, by preference from a fatal 

 case of erysipelas, inoculated into small flasks of bouillon, and allowed to grow for 

 three weeks. The flask is then reinoculated with Bacillus prodigiosus, allowed 

 to grow for ten or twelve days at the room temperature, well shaken up, poured 

 into bottle of about f5ss capacity, and rendered perfectly sterile by an exposure 

 to a temperature of 50 to 6oC. for an hour. It is claimed that the combined 

 products of the streptococcus of erysipelas and Bacillus prodigiosus are much 

 more active than a simple streptococcus culture. The best effects follow the 

 treatment of cases of inoperable spindle-cell sarcoma, where the toxin sometimes 

 causes a rapid necrosis of the tumor tissue, which can be scraped out with an 

 appropriate instrument. Numerous cases are on record in which this treatment 

 had been most efficacious; but, although Coley still recommends it and Czerny 

 upholds it, the majority of surgeons have failed to secure the desired results. 



Antistreptococcus Serum. Since 1895 considerable attention 

 has been bestowed upon the antistreptococcus serum of Marmorekf 

 and Gromakowsky,! which is said to act specifically upon strepto- 

 coccus infections, both general and local. Numerous cases of 

 suppuration, septic infection, puerperal fever, and scarlatina are 

 upon record in which the serum seems to have exerted a beneficial 

 action. 



The serum is prepared by the injection of cultures of living 

 virulent streptococci into horses, until a high degree of immunity is 

 attained. The serum is probably both antitoxic and bactericidal 

 in action. 



The success following the serums of some experimenters upon 

 certain cases, and their occasional or constant failure in other 

 cases, have suggested that there is considerable difference between 

 different "strains" or families of streptococci. To obviate this 

 inequality Van de Velde has made a polyvalent antistreptococcus 

 serum by using a number of different cultures secured from the 

 most diverse clinical cases of streptococcus infection. Another 

 serum, of Tavel|| and Moser,**is made by using cultures from dif- 

 ferent cases of scarlatina. The use of these serums, however, has 

 not given the satisfaction expected, and at the present moment 

 the whole subject of antistreptococcus serums is debatable both 



* " Amer. Jour. Med. Sci.," July, 1894. 



t "Ann. de Plnst. Pasteur," July 25, 1895, rx, No. 7, p. 593- 

 Jlbid. 



"Archiv. de. med. Exper.," 1897. 

 "-|| "Deutsche med. Wochenschrift," 1903, No. 50. 

 ** " Berliner klin. Wochenschrift," 1902, 13. 



