"The liver cells are either cloudy or decidedly fatty; the microscopic evidences of fatty degeneration are present" (8). "The hepatic cells show changes of an intense acute degeneration, much more marked than are found in any other disease except acute yellow atrophy of the liver" (9). "In cases of a rapidly fatal termination, the discoloration may appear only in patches; the inter-lobular connective tissue is often swollen (and, according to Kippax, dryer than normal), and contains, in places, accumulations of embryonal connective tissue" (10). YELLOW FEVER. "The kidneys are large, soft and congested, and the microscope reveals the existence of diffuse nephritis"(12) ARSENICATION. "Fatty degeneration of the kidney may be produced in arsenical poisoning" (11). (4-9.) Pathological Anatomy by Delafield & Prudden; vol. 1, p. 819. (8-10-12.) Guiteras in Keating's Cyclopedia of Diseases of Children, vol. 1, p. 861. (11.) Pathological Anatomy and Histology, Delafield & Prudden, 5th edit. p. 819. "These also rapidly become inflamed and undergo change in the tissue, beginning with the parenchyma; they are usually found somewhat enlarged, pale and soft, and, on section, show a thickened cortex and a yellowish-gray color, first on the surface, and, later, in spots and streaks, when fatty degeneration has affected the tubules" (3). ARSENICATION. "This organ is in normal condition if death occurs early; but, if life has been prolonged for some hours, the walls are usually less firm, look pale and yellowish, and under the microscope show signs of fatty degeneration" (9). "Another common appearance in arsenic poisoning is ecchymosis on the muscular tissue under the endocardium; this may be found all over the interior of the heart, but is generally to be seen on the left ventricle" (10). (1.) Kippax on Fevers, 1881, p. 208. (2.) A. McL. Hamilton's "System of Legal Medicine"; vol. 1, p. 279. (3.) Pathological Anatomy and Histology, Delafield; vol. 1, p. 819. (4-7.) Guiteras in Keating's Cyclopedia of Diseases of Children; vol. 1, p. 864. (5.) Delafield and Prudden, vol. 1, p. 279. (6.) Kippax on Fevers, 1884, p. 209. (9-10.) A. McL. Hamilton's "System of Legal Medicine"; vol. 1, p. 371. "Under the microscope I found the muscular fibers generally healthy; a few are found with some granulations about the nucleus" (7). "Softening of the heart, with molecular degeneration of its fibers, is usually met with" (8). "Sub-endocardial extravasations, most marked in the left ventricle about the columnæ carnæ, have been observed by Wilks, Bonavia and McLeod" (11). (8.) Robert's "Practice of Medicine", 1880, page 239. (11.) W. B. Hills in "The Reference Handbook of Med. Sciences"; vol. 1, p. 345. Among the cancer cures which have been exploited in the recent past, that which is known as the toxine treatment is well worthy of our consideration. By this phraseology is meant the treatment of malignant disease by the administration to the patient of the poisonous products of the life and development of erysipelatous streptococci. HISTORY: The first suggestion of the curative value of erysipelas in cancer occurred through the accidental contraction of erysipelas by a cancer case. Such accidental cures occurring at remote intervals finally resulted in experiments as early as 1882 by Ricord and Fehleisen. These experiments were made with the living cultures of erysipelas. The difficulty however of obtaining such at short notice, and the danger to the life of the patient in inducing such a disease, (several deaths having occurred,) discouraged further investigation and experiments in this line. Later, after fuller study of microbic life, it was discovered that the poison. ous products of the growth and development of these organisms, when injected into living animals, were capable of producing symptoms very similar to those resulting from the living microbes themselves; and, in carefully regulated doses, without danger. With this light, Lassar, of Berlin, Spronck, of Holland, and Coley of New York, each working independently, conceived that the toxines of the erysipelatous streptococcus might exert the same curative action upon cancer, as an attack of erysipelas itself. Experiments have proceeded sufficiently far at the present time to enable us to state emphatically that some forms of malignant disease are neutralized and cured by this treatment. A great obstacle met in the preparations of the toxines is the difficulty in maintaining a standard strength for the same. It is well known that cases of erysipelas vary markedly in their virulency in different individuals. The toxine resulting from a graft of a mild case is of inferior efficiency. Again, successive cultures from what has originally been a virulent case, steadily lose their toxicity with each successive generation. It was discovered by Roger that the bacillus prodigiosus when grown, in company with the erysipelatous streptococcus markedly increased the virulency of the latter. Seizing upon this suggestion, Doctor Coley, in 1892, began to use the combined toxines of the two bacilli and has continued the same to the present time. At first the two toxines were mixed at the time of using in the proportion of one part of the prodigiosus to four or five of the erysipelatous. The immedidiate effects of the sub-cutaneous injection of such combination was found to be much more marked than from any preparation which had previously been tried. It was found, also, that there could be produced with a fair degree of constancy, rigors, coming on in from one-half hour to one hour, nausea, vomiting, headache, and elevation of temperature to 103 or 104° F. These symptoms were produced with the use of from m ss. to m VIII according to the original virulency of the graft and the reactive force of the patient, More recently a still further step has been taken in the preparation of the toxines by growing the bacilli together in the same bouillon. The erysipelatous streptococci being cultivated alone for ten days, then the bacillus prodigiosus added and the two cultivated together for another ten days. Up to this time the fluid used for injection was a filtrate obtained from the culture bouillon thus prepared. Still later, the whole culture broth containing the dead bodies of the germs rendered inert by heating to a temperature sufficient to sterilise them, has been used and found superior in strength and curative effect to any heretofore utilised. One-half a minim of toxine thus prepared, injected beneath the skin, has produced prolonged rigors and a temperature of 10412 F. METHOD OF ADMINISTRATION. Doctor Coley recommends that treatment be begun with a very small dose from m. ss. to m. I. repeated daily, gradually increasing the dose until distinctive rigors are produced, and elevation of temperature to 103 or 104 F. From the moderate experience of the writer of this article the question has arisen whether it is necessary to induce such profound constitutional symptoms in order to obtain the desired result. A case which I shall report seems to substantiate such a view. IS THERE ANY RATIONAL EXPLANATION TO ACCOUNT FOR CURATIVE EFFECTS OF TOXINE TREATMENT OF CANCER? Unfortunately we are in gross ignorance of the nature of malignant disease. We can only say that it is a cell proliferation from an unknown cause. The microbic origin of malignant disease is a plausible theory which we should be glad to accept, could we have sufficient data upon which to base it. Unfortunately all investigations have thus far failed in establishing such a doctrine. Perhaps there has been nothing however evolved which makes the microbic theory more plausible than this effect of erysipelas and its toxines upon cancer. We are fairly familiar with the strep |