COLEY'S FLUID 79 



the same class of patients in the Pasteur institutes, the death rate 

 of all cases, early and late, has been reduced to a fraction of i per 

 cent. Those cases in which the bites are on the head, are always 

 more serious, and the mortality is higher. Like tetanus the 

 virus travels, it is supposed, from the site of injury to the central 

 nervous system by way of the nerves. If the bite was on the toe, 

 it would take longer for infection to reach the brain, than if it was 

 on the upper lip. This is a very plausible explanation of the vary- 

 ing incubation periods in both tetanus and hydrophobia. 



Coley's Fluid in the Treatment of Tumors. 



This method of treatment is in no wise a prophylactic one, but 

 strictly a curative one. It consists in the injection of the toxins of 

 streptococci, in the hope that they will cause a shrinking, or disap- 

 pearance of malignant sarcomata. An attack of erysipelas (it has 

 long been observed) occurring in a patient with some malignant dis- 

 ease, has the effect of causing a disappearance, or retrogression, of 

 the tumors. Artificial infection with streptococci was then practiced 

 with the idea that it might produce the same effect. But this was 

 found to be dangerous. Coley prepared toxins of streptococci by 

 allowing them to grow with the B. Prodigiosus. The mixture after 

 a long period of incubation was sterilized by heat, and the fluid thus 

 obtained was injected into the tissues. Virulent strains of strep- 

 tococci are used and the dose of the dead culture is about half a drop 

 given under strict anti-septic precautions. Out of 200 cases many 

 were cured. In 35 cases treated by other surgeons 26 tumors dis- 

 appeared, and 14 of these cases were alive from two to four years 

 after. The best results are obtained in spindle cell sarcoma, 

 and the poorest in the melanotic variety. The method by no means 

 should be employed where the tumor can be removed by operation. 

 It cannot supplant the knife, and only in inoperable cases or as a 

 supplementary treatment where other forms of treatment are 

 employed, should it be used. 



