OF ABSCESSES, CELLULITIS AND SEPTICAEMIA 343 



celled variety. A number of cases of round-celled sarcoma in which the 

 diagnosis was unquestioned disappeared, and the patients have remained 

 \\ell beyond three years. Nearly half of the cases treated showed no 

 appreciable decrease in si/.e; the majority of the others which did show 

 marked improvement 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 had disappeared entirely, and the majority of the successful cases 

 have remained well sufficiently long to justify their being regarded as cured. 

 It should be distinctly stated that all of the tumors under consideration 

 were inoperable, as I have never advised treatment except in such cases. 



"I have now a number of cases of spindle-celled sarcoma which 

 have remained well beyond three years; one case of mixed (round and 

 spindle) celled, after remaining well three years, had a return in the 

 abdomen, and died about eight months later. The result here certainly 

 establishes the correctness of the early diagnosis." 



PRODUCTION OF Toxic SUBSTANCES. There is no doubt that the 

 streptococcus causes fever, general symptoms of intoxication, and death 

 by means of toxic substances which it forms in its growth; but we 

 know but little about these substances or how they are produced. The 

 poisons while partly extracellular are mostly contained in the cell sub- 

 stance. Heat destroys a portion of them. They appear to attack 

 especially the red blood cells, and this ha?molytic action seems to be to 

 some degree in proportion to the virulence of the organism. 



SUSCEPTIBILITY TO STREPTOCOCCUS INFECTION. As with the ever- 

 present staphylococci, whose virulence, as we have seen, is usually 

 slight, the streptococci are more likely to invade the tissues, forming 

 abscesses or erysipelatous and phlegmonous inflammation in man 

 when the standard of health is reduced from any cause, and espe- 

 cially when by absorption or retention various toxic organic prod- 

 ucts are present in the body in excess. It is thus that the liability to 

 these local infections, as complications of operations or sequela? of 

 various specific infectious diseases, in the victims of chronic alcoholism, 

 and constitutional affections, etc., are to be explained. It seems estab- 

 lished that the' absorption of toxic products formed in the alimentary 

 canal as a result of the ingestion of improper food, or in consequence 

 of abnormal fermentative changes in the contents of the intestine, or 

 from constipation, predispose to infection. 



Immunity. Knorr succeeded in producing a moderate immunity 

 in rabbits against an intensely virulent streptococcus by injections of 

 very slightly virulent cultures. Pasquale was able to immunize these 

 animals partially against septica?mia. Marmorek has immunized 

 sheep, asses, and horses against very large doses of a streptococcus, 

 which though but slightly virulent for them was intensely so for rabbits. 



In none of the streptococcus inflammations do we notice much appar- 

 ent tendency to the production of immunizing and curative substances 

 in the blood by a single infection. 



Severe general infections usually progress to a fatal termination 



