398 COCA AND GILMAN. 



become sn-aller, softer and more freely movable. At Uie end of another week — 

 i. e., two weeks after the injection of vaccine — a section extending to the center 

 of the tumor was removed for histologic examination. This showed a dense, 

 thick, fibrous capsule and central reticulum, in the meshes of which were found. 

 nests of large cells in all stages of degeneration and necrosis together with 

 invading lymphoid and plasma cells, and macrophages. January 3., 1910; the 

 nodule in the neck has not increased in size, is freely movable, and feels as if it 

 were a mass of scar tissue. Healing is otherwise complete and tliere are no 

 signs of. recurrence. 



Case 3. — No. 8444. Filipino aged 44 years. Carcinomatous cyst of left neck 

 involving structures practically similar to case No. 8175. Operation and inoc- 

 ulation of vaccine 'Novemler 22, 1909. January 3, 1910, neck is completely 

 healed and soft and there are no signs of carcinoma, although at the operation 

 a definite portion of tiunor tissue was left adherent to the sheath of the vessels 

 and to the horn of hyoid bone. 



Case 4.— No. 8326. Filipina aged 71 years. Advanced carcinoma of left 

 buccal mucosa involving entire cheek and, by extension, the side of tlie neck. 

 Operation November 10, 1909; removal of as much tumor as possible and left 

 half of lower jaw; block dissection of the neck. Carcinomatous tissue remained 

 unexeised at the base of the tongue and left pillar of fauces. Inoculation of 

 vaccine November 10, 1909; death from intercurrent affection December 18, 

 1909. At autopsy absolutely no sign of malignant tissue was found locally or 

 anywhere in the body, the unexeised portions of malignant tissue having disap- 

 peared from the base of the tongue and from the pillar of fauces. 

 ' Case 5. — No. 8442. Spaniard, male, aged 40 years. Carcinoma springing 

 from some deep epithelial structure of right upper neck, involving all deeper 

 structures, parotid and submaxillary glands, and overlying skin. At the opera- 

 tion December 7, 1909, it was found impossible to remove all of the malignant 

 tissue. In addition to a mass surrounding the great vessels, two large nodules, 

 measuring about 2.5 by 3 centimeters were left superficially, one posterior to and 

 below the angle of the jaw and the other in the region of the submaxillary gland 

 extending outward to the level of tlie cheek and upward behind the jaw toward 

 the base of the tongue. 



Injection of vaccine was made December 7, 1909. On the seventh day thereafter 

 the first nodule was found to be converted into a soft, fluctuating area suggesting 

 a pocket of pus, although lacking all signs of inflammation. The wound had 

 healed cleanly by first intention. This fluctuating area opened spontaneously 

 through a small passage left by a stitch opening. Cultures taken from the 

 contents the next day sliowed Utaphylocorcus aureus and alhus. Under simple 

 dressings the area has healed and the nodule has entii'ely disappeared. The 

 second nodule in the submaxillary region has grown gradually smaller and less 

 board-like until to-day, January 3, 1910, it has almost disappeared and the skin 

 and superficial structures, excepting in one small area, have become normally 

 soft. The patient is able to swallow with much greater ease than he could before 

 the treatment. He is still in the hospital under observation. 



Case 6.— No. 8233. Filipino aged 49 years. Fungating carcinoma involving 

 practically the whole of the right neck in its lower half and extending behind 

 clavicle. First operation October 30, 1909, at which time apparently the entire 

 growth was removed. No treatment by vaccine was given as the material was 

 spoiled. There was a prompt local recurrence within a week. 



The second operation was performed when sufficient amount of tumor had 

 grown to supply material for making the vaccine. Only the most superficial 



