358 Suppuration 



which was independent of their virulence. This poison is 

 liberated only when the bactericidal activities of the body 

 act upon the cocci. The cocci also excrete a toxic substance 

 whose activity is greater than that of the intracellular toxin, 

 but whose production is subject to great variation and is 

 entirely independent of the intracellular toxin. The toxins 

 and hemolysins are entirely different bodies. 



In general, the effects of streptococcus intoxication are 

 vague. The animals appear weak and ill, and have a 

 slight fever; but unless the virulence of the culture be 

 exceptional or the dose very large, they usually recover in 

 a short time. 



Coley 's Mixture. The clinical observation that occa- 

 sional 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 Streptococcus 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 in- 

 jection. A virulent culture of the streptococcus is obtained, 

 by preference from a fatal case of erysipelas, inoculated into 

 small flasks of slightly acid bouillon, and allowed to grow 

 for three weeks. The flask is then reinoculated with Bacil- 

 lus prodigiosus, allowed to grow for ten or twelve days at the 

 room temperature, well shaken up, poured into bottles of 

 about f5ss capacity, and rendered perfectly sterile by an 

 exposure to a temperature of 50 to 60 C. 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 has been most efficacious; but, although Coley 

 still recommends it and Czerny upholds it, the majority of 

 surgeons have failed to secure the desired results. 



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



