396 COCA AND GILMAN. 



still retains its specific biological characters, we do not know. However, 

 the efficacy of a single large injection is amply shown in cases 2, 3, and 

 4 of group IV. 



The degree of local reaction of the tissues to the injections has varied 

 from absolutely none whatever (case of Hodgkin's disease) to abscess 

 formation (two cases of carcinoma). In neither of these latter cases 

 were the ordinary pus organisms found. One was sterile (five cultures 

 having been taken on agar and blood serum) and the other, situated 

 in the subcutaneous tissues of the abdomen and opened four hours after 

 death, contained only B. coli communis and B. proteus vulgaris. 



In one case, following the experiments of Gorowitz, a normal indi- 

 vidual received at the same time as the cancer patient the same injec- 

 tion. The local reaction in the control was, if anything, more vigorous 

 than in the patient from whom the cancer tissue was derived. This 

 single experiment, however, can not be considered as contradicting the 

 investigation of Gorowitz, since, in our case, the amount injected was 

 so great as possibly to conceal the small differences that might be 

 evident after the injection of smaller quantities. 



We have divided the fourteen cases which form the basis of this 

 preliminary report into four groups in the hope . of conveying a clear 

 understanding as to the type of case with which we were dealing in 

 each instance, as to the extent of the effect which the "vaccine" has 

 exerted, and, finally, as to what would have been the probable course of 

 the disease if surgery unaided had been depended upon.. In group I 

 we have included those cases which were considered curable by opera- 

 tion, where the growth and its visible extensions were readily and natur- 

 ally removable. In group II we have placed those cases probably 

 curable by operation, those in which the removal though possible was 

 more difficult by reason of the infiltrating character of the growth. In 

 group III we have placed those of doubtful curability by operation, 

 those cases where even with radical measures carcinomatous material 

 was probably unavoidably overlooked and not removed. In group IV 

 we have included those positively inoperable tumors, in which the 

 extent of the growth absolutely precluded its complete removal and 

 definite carcinomatous material was seen to remain in the wound. 



GROXIP I. — CASES CURABLE BY OPEEATION. 



Case 1. — No. 7177. Filipino aged 80 years. Ulcerated carcinoma of riglit 

 forearm with metastases to glands at elbow. Operation May 19, 1909, complete 

 removal of all visible carcinomatous tissue and glands. Inoculation of cancer 

 vaccine May 19, 1909. No signs of recurrence on January 3, 1910. 



Case 2. — No. 7419. Filipina aged 39 years. Carcinomatous degeneration of 

 ulcerated fibro-myoma of cervix, with no visible involvement of lymphatics. 

 Operation, pan -hysterectomy, July 5, 1909. Inoculation of cancer vaccine July 

 5. 1909. No signs of recurrence January 3, 1910. 



