STREPTOCOCCUS PYOGENES. 485 



cases has been largely carried out by or under the 

 direction of Dr. Coley. He has kindly sent me the 

 following notes on his results : 



" The improvement and inhibitory action which the 

 toxins have upon carcinoma have proved to be, in 

 nearly all cases, but temporary, and in no case has 

 the disease remained in abeyance sufficiently long to be 

 regarded as cured. 



" On the other hand, in sarcoma, which is the only 

 form of malignant tumor in which I have advocated 

 the treatment, sufficient time has elapsed to enable us 

 to draw the following conclusions : 



" The toxins injected subcutaneously into the tissues, 

 either into the tumor substance or into parts remote 

 from the tumor, exercise a distinctly inhibitory action 

 upon the growth of all varieties of sarcoma. This 

 action is the least marked in melanotic sarcoma, and 

 tli us far no cases of this form of tumor have disap- 

 peared under the treatment. The influence of the 

 toxins upon round-celled sarcoma is much more pow- 

 erful than it is upon melanotic, although distinctly less 

 than upon the spindle-celled variety. A number of 

 cases of round-celled sarcoma in which the diagnosis 

 was unquestioned disappeared, and the patients have 

 remained well beyond three years. Nearly half of the 

 cases treated showed no appreciable decrease in size; the 

 majority of the others which did show marked improve- 

 ment at first, after decreasing in size for a few weeks, 

 again began to increase and were no longer influenced 

 by the treatment. 



" In half of the cases of spindle-celled sarcoma 

 treated by the toxins the disease has disappeared 

 entirely, and the majority of the successful cases have 



