342 BACTERIA PATHOGENIC TO MAN 



pyogenic cocci, is responsible for the local inflammation and its results. 

 These forms of so-called diphtheria, as first pointed out by Prudden, 

 are most commonly associated with scarlatina and measles, erysipelas, 

 and phlegmonous inflammation, or occur in individuals exposed to these 

 or other infectious diseases. So uniformly are streptococci present in 

 the pseudomembranous inflammation of patients sick with scarlet 

 fever, that many investigators have suspected a special variety of them 

 to be the cause of this disease. The same is true for smallpox. Many 

 varieties are regularly found, however, in the throat secretion of healthy 

 individuals (in 100 examinations by us we found them in 83, and probably 

 could have found them in some of the others by longer search). Their 

 presence in scarlet fever and smallpox is most probably due to their 

 increase in the disordered mucous membrane and entrance into the cir- 

 culation when the protective properties of the blood have been lowered. 



The causal relation of the streptococcus to the above-mentioned 

 diseases has been amply proved by inoculation experiments both in man 

 and animals. Fehleisen has inoculated cultures, obtained in the first 

 instance from the skin of patients with erysipelas, into patients in the 

 hospital suffering from inoperable malignant growths lupus, carcinoma, 

 and sarcoma and has obtained positive results, a typical erysipelatous 

 inflammation having developed around the point of inoculation after a 

 period of incubation of from fifteen to sixty hours. This was attended 

 with chilly sensations and an elevation of temperature. Persons who 

 had recently recovered from an attack of erysipelas proved to be immune. 

 These experiments were undertaken on the ground that malignant 

 tumors had previously been found to improve or entirely disappear in 

 persons who had recovered from accidental erysipelas. During the last 

 few years this fact has been therapeutically applied to the treatment of 

 malignant tumors by the artificial production of erysipelas by the 

 inoculation of pure cultures of streptococcus or of their toxic products. 



RESULTS FROM INJECTIONS IN TUMORS. In some cases of sarcoma 

 this method has met with considerable success; in carcinoma, however, 

 the results have been very slight. In this country the experimental work 

 upon this subject and the actual treatment of cases have been largely 

 carried out by or under the direction of 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. 



" 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 nearly all varieties of sarcoma. 

 This action is the least marked in melanotic sarcoma, and thus far no 

 cases of this form of tumor have disappeared under the treatment. The 

 influence of the toxins upon round-celled sarcoma is much more powerful 

 than it is upon melanotic, although distinctly less than upon the spindle- 



