MISCELLANEOUS DISEASES 219 



When the tumor is small, not necrotic or ulcerated, there may re- 

 sult little or no temperature reaction or malaise following the in- 

 jection and relatively little local effect. There may be a slight increase 

 in pain at the focus and some evidence of an increased inflammatory 

 reaction, but the size of the tumor will not alter materially. In- 

 deed at times the rate of growth is increased. 



When we deal with a large tumor mass, with either central necrosis 

 or ulceration, nonspecific injections are as a rule followed by a de- 

 cided rise in the temperature and a feeling of malaise. The further 

 course will be determined by the effect on the local pathology. There 

 is usually a marked increase in the pain and evidence of inflammation, 

 digestion takes place of the necrotic material and the tumor may be- 

 come apparently smaller in size. The general condition of the pa- 

 tient at this time will vary with the amount of the protein split 

 products which are absorbed. If large in amount and but partially 

 digested, the temperature will continue high for a period of several 

 days; if small in amount, or if more completely digested at the focus 

 before absorption, then the temperature reaction may fall within the 

 limits of the provocative temperature of the nonspecific agent injected. 

 In either case, in the period of recovery from the nonspecific re- 

 action and from the reaction caused by the absorption of the auto- 

 lytic tumor products, the balance swings to the reparative side and 

 a general euphoria with increased appetite, lessened pain and ir- 

 ritability, improved nutrition and feeling of strength may set in 

 which will last for a variable period. If a diminution of the size of 

 the tumor (because of the digestion of necrotic material) has oc- 

 curred at the same time, the natural inference of curative effects 

 are prone to further encourage both the patient and the physician. 

 This clinical reaction has been the basis of practically all of the 

 methods of therapy which have at various and sundry times been re- 

 ported and it is quite possible that it takes a part in the reaction 

 that follows after Roentgen and radium treatment, although by no 

 means must it be held accountable for all the effect there achieved. 



We cannot avoid the conclusion that the nonspecific reaction has 

 little or no effect on the rate of growth of the malignant tissue as 

 long as it is well supplied with vascular connections. Once the 

 tumor cells become necrotic or perhaps undergo some of the earlier de- 

 generative changes, digestive stimulation such as that which follows 

 nonspecific therapy has an apparent effect similar in character and 

 range to that observed in other pathological conditions. 



On repeated injections the effect becomes less manifest and the 

 reaction usually less severe, depending, of course, on the amount of 

 necrosis present in the tumor. One finds that not only the commonly 

 used nonspecific agents, but even iodin injections are followed by 

 alterations in the tumor and a febrile reaction due to focal diges- 

 tion. Moresowa has demonstrated this fact in a series of cases. 



