9. The bacillus prodigiosus immensely increases the reaction.
10. The effect is most striking in the case of rapidly growing sarcomata.
H. Treatment should be continued until the whole growth has vanished or has become so small that it can be re moved.
12. If there is a recrudescence of the disease it does not follow that the toxins will be as efficacious the second time as they were the first.
13. Recurrence in other parts of the body may take place after many years.
C. Mansell MonIlin (Lancet, Feb. 5, '93).
Conclusions in regard to the treatment of malignant tumors with the mixed toxins of erysipelas and bacillus prodigi osus are as follow: 1. The mixed toxins of erysipelas and bacillus prodigiosus have an inhibitory action upon the growth of malignant tumors of whatever variety.
2. This influence is far more marked in sarcoma than in carcinoma, and differs very markedly in the different varieties of sarcoma, being most pronounced in the spindle-celled variety, and least in the melanotic.
3. A considerable number of inoperable sarcomata, the correctness of the diagno sis of which is beyond question, have en tirely disappeared under this method of treatment.
4. A large portion of these cases have remained free from recurrence more than three years after treatment.
5. The action of the toxins upon sar coma must be regarded as a rapidly pro gressing necrobiosis, with fatty degenera tion.
6. This method of treatment is at tended with some risk unless certain pre cautions are taken. These risks are: (a) collapse from too large a dose, espe cially when injected into a very vascular tumor; (b) pymmia from insufficient care as regards asepsis, especially in the presence of a granulating or sloughing surface. That these risks are slight is
shown by the fact that, in upward of two hundred cases of malignant tumor treated personally, death occurred in but two as a result of the treatment.
7. The use of small closes of the toxins for a short time after primary operation as a prophylactic measure theoretically has much to recommend it.
S. The action of the toxins upon sar coma, as shown by the clinical results, is in strict accordance with the known action of the living streptococcus of ery sipelas. Hence the method rests upon a perfectly logical and scientific basis.
9. The toxins, to be of value, must be prepared from highly-virulent cultures of the streptococcus of erysipelas. Coley (Practitioner, Apr., '99).
Statistics of 113 cases of inoperable malignant growth treated with erysipelas toxin. Of these. 62 were sarcomas and 53 carcinomas. Of the 62 sarcomas, 11 were cured (Kleeblatt, 1; Mynter, 1; Coley, 9): a proportion of 17.74 per cent. Twenty-eight cases were considerably improved (Spronk, S; Friedrich, 1; Coley, 19), or 45.10 per cent. The other 23 cases showed a temporary improve ment, or failed to respond. Of the 53 carcinomas, 22, or 41.5 per cent., showed some temporary improvement, and the rest (31 cases) gave completely negative results. Filippo Scuderi (Gazzetta Med. Lombardi, June 10, 1900).
Any growing tumor of the breast should be removed, and any angiomatous spots (spider patches) should be watched, and, as soon as they start growing, should be gotten rid of, more for cosmetic reasons than for fear of harm to the functions of the organ.
[For x-ray treatment see various ana tomical subdivisions: Tumons OF BREAST, etc.]