John Gay

French, M.D., F.R.C.S.

In No. XXXI of the " Indian Annals of Medical Science July 1873, there is a most instructive paper on abscess in the liver and pneumatic aspiration, by Dr. J. F. P. McConnell. The histories of 14 cases are there clearly recorded, and the temperature charts of live cases given. I find that in

nearly all, the bowels were constipated or regular; in two they were loose, and in one they were constipated on admission,

but became too free afterwards. In 12 cases out of the 14 there were local signs of abscess. In one (No. XII case) the liver was enlarged and descended " On the 9th two fingers' breadth below the ribs." day it was thought that slight fluctuation existed a little below and to The exploring needle the right side of the ensiform. cartilage. was introduced, and the aspirator drew off some reddish brown

chocolate-colored thin pus. In the other case (No. XIV) "a distinct swelling a little to right of epigastrium was perceived ; this increased rapidly, and as an abscess was suspected, or

the patient was operated upon." It is thus evident that in all tue 14 oases, there were more or less distinct local symptoms of



or hepatic disease; and they show the ordinary course symptoms of the disease in India. In such cases there can be no doubt as to our treatment, and, for my own part, I consider the results in Dr. McConnell's cases satisfactory and

absces3 and

and then, however, meet with cases in which there is no local sign whatever of abscess or hepatic disease, but, on the contrary, the local symptoms may be against abscess, and mislead us. These are the puzzling cases, where our diagnosis is based upon the general symptoms. Now




has come to

aid in

forming a diagnosis, importance than they were in former days, when the physician was naturally reluctant to explore with a trocar and canula, unless he saw or felt a distinct local symptom of abscess. Out of eight undoubted cases of abscess in the liver?where the diagnosis was proved by the withdrawal of the pus, or post-mortem examination, of which I have now the notes before me?I find that in four (all Europeans) there was not the slightest local symptom of abscess or hepatic disease. In another case which, owing to the kindness of Dr. S. Coull Mackenzie, I saw treated in his ward, although there were considerable enlargement of the organ and a previous history of hepatitis, there was no local symptom of fluctuation, or sign of abscess. After death we found a large abscess in the right lobe. I had another case of an officer, in which I diagnosed abscess of the liver from the general symptoms only ; there was no local sign, but as no post-mortem was allowed I

that the these


general symptoms



of more

exclude it from my list. The first case I met with was in an

European Artilleryman,

whom I saw, with Surgeon-Major T. Wright in Dinapore, in October 1861. The diagnosis was obstinate diarrhoea and remittent fever. There were daily a number of liquid, offensive,

stools, a remittent sort of fever, night sweats, progressive prostration. There was no enlargement of



the liver or apparent disease of any orgnn, and the man died from exhaustion. At the post-mortem we found a large abscess in the right lobe, and no trace of any other disease. The second case was as follows:?Prisoner Henry W., aged 30, in jail for past 46 months, was admitted into hospital in the European Penitentiary, Hazareebagb, on 30th May 1872, for ague. On 3rd June, he was well. On 10th June, he complained of pain in the chest, but no abnormal sounds or conditions could be detected. On 11th, he complained of sore throat, which got well in a few


On 13th and

14th, ho had fever at night. 29th, he continued to improve, but suffered from despondency and lowness of spirits On 30th he had again fever and constant vomiting On 1st and 2nd July, no fever ; pulse 70 ; tongue furred, but moist; sleeps well. Ou 4th and 5th had attacks of vomiting, but sleeps well ; no fever; abdomen carefully examined, but nothing abnormal From 15th to

detected. 10

Notes on Liver Abscess.

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