SPECIFIC TREATMENT OF CARCINOMA. 399 



portions of the fungus were scraped away as the patient was in very bad con- 

 dition. At this time a tumor of the right shoulder was observed, which had 

 previously escaped notice. This mass extended over the entire shoulder so that 

 the contour was not very markedly altered. This shoulder mass grew rapidly 

 within the next five days and was hard and brawny; the overlying skin became 

 infiltrated and roughened and the arm oedematous. 



On the seventh day after treatment with the vaccine there was noted a marked 

 local disturbance in the shoulder. The skin temperature of the carcinomatous 

 area was markedly increased above that of the rest of the body, which was 

 normal. The tumor was painful, the skin darker and congested, and the entire 

 mass distinctly softer. 



The following day, the eighth after treatment, the temperature difference 

 was less marked, the pain less, and the softening more pronounced, amounting 

 almost to fluctuation. Under cocaine, anaesthesia the shoulder was incised for 

 the purpose of obtaining material for microscopic and bacteriologic examination. 

 Cultures remained sterile; smears showed the presence of only a small number 

 of polymorphonuclear leucocytes, and large numbers of epithelial-like cells. 

 Sections of the excised tissue showed typical carcinomatous growth identical 

 with that of the original tumor. Several recurrent masses along the upper 

 portion of the neck wound had, during this period, undergone softening and 

 atrophy. The main wound remained clean and free from recurrence, the edges 

 had advanced a centimeter and a half toward the center by a growth of apparently 

 healthy epithelium and a large carcinomatous mass left behind the clavicle became 

 markedly discolored and shrank perceptibly in size. The patient died four days 

 later. Autopsy showed a tumor mass in the mediastinum that had not been 

 noted, and the cause of death to have been hydropericardium, right hydrothorax, 

 and oedema of the left lung. 



Cases 7 and 8. — Nos. 8405 and 8497. These cases are under treatment at 

 present. In each of them, large masses of carcinoma, involving the bladder and 

 ureters, the rectum, and pelvic fasciae, were present and only portions were 

 removed for making a vaccine. 



Too short a time has elapsed to make it possible to anticipate the 

 effect of the treatment upon the course of the disease. In cases 7 and 8, 

 however, this much can be said : in each of the cases the marked cachexia 

 that was present before the treatment has entirely disappeared. 



The disappearance of the cachexia;, which was noted within three days 

 after treatment, must be looked upon as a remarkable phenomenon. Ac- 

 cording to all theories hitherto advanced in explanation of tumor ca- 

 chexia, the injection of large quantities of tumor material should have 

 increased rather than diminished the symptoms. 



The experiments of Gorowitz, together with those of Friedberger 

 dealing with the nature of anaphylaxis, seem to offer the most satisfactory 

 basis of explanation for the cachexia of malignant tumor. Gorowitz 

 has demonstrated in cancer patients a condition of hypersensitiveness 

 to the cellular substances of their own tumors. This condition was 

 absent in normal individuals. We are forced thus to conclude that 

 sufficient quantities of the tumor cell substances enter the circulation to 

 produce in tlie body the condition referred to. 



