STREPTOCOCCIC VACCINE 283 



groups. Sera for each group are specific for the group 

 and furnish no protection against the other groups. Anti- 

 streptococcic serum has been employed in streptococcal 

 infections, such as erysipelas, cellulitis, puerperal fever, 

 and pyaemia. It frequently fails, and is probably most 

 successful in erysipelas. 



A vaccine prepared by sterilising cultures with heat has 

 been used with benefit in streptococcic infections which 

 do not run too rapid a course, e.g. infective endocarditis, 

 and streptococci are frequently introduced into preven- 

 tive vaccines for influenza and its complications, bron- 

 chitis and coryza. Sensitised streptococcal vaccine 

 (p. 266) seems to be useful in wounds with streptococcal 

 infection. 



Coley's Fluid 



This preparation consists of the toxins of the streptococcus of 

 erysipelas and the B. prodigiosus. It was devised by W. B. 

 Coley, of New York, as a cure for inoperable malignant tumours, 

 particularly sarcoma. The treatment is based on the undoubted 

 fact that malignant growths may decrease, or even disappear 

 completely, after an attack of erysipelas (p. 281). Originally 

 prepared by growing a virulent streptococcus obtained from a 

 fatal case of erysipelas in bouillon for about ten days ; the culture 

 is then inoculated with the B. prodigiosus, and the two are allowed 

 to grow together for another week or ten days. The culture is 

 finally heated to from 58 to 60 C. for one hour, and a piece of 

 thymol added to preserve it. The fluid is now prepared by grow- 

 ing the organisms separately and then mixing the two sterilised 

 cultures in proper proportions. 



The fluid is injected subcutaneously in the vicinity of the 

 tumour. The primary dose recommended is minim of the fluid. 

 The dose is gradually increased each day until there is a tempera- 

 ture reaction of 103 to 104 F. 



Full particulars will be found in Coley's papers (Proc. Roy. Soc. 

 Med.,vol. iii, 1909-10, Surg. Sect., p. 1 ; ibid., vol. vi, 1913, p. 35 ; 

 Ann. Surgery, vol. xx, 1919, p. 633). 



