rn aS ees ee 
eS Tee Teor. 
556 
majority of instances the clinical findings will justify a diagnosis, which 
may be confirmed by evacuating a portion of the contents of the abscess 
through an exploring needle. Experience teaches the physician to be 
conservative in making these diagnoses during life, because fever, en- 
largement of the liver, pain, and the other common symptoms and the 
usual results of blood examinations may be quite well marked without the 
presence of an abscess, and again, a fairly large abscess may show almost 
no symptoms, even after a most complete and careful examination. 
Physical signs.—The liver usually shows some enlargement, partic- 
ularly if the right lobe is involved, and Osler has pointed out that this 
enlargement is usually more upward than it is downward. However, 
this condition is not so important in the Tropics, where some enlargement 
of the liver in foreigners and others most liable to abscesses is of rather 
frequent occurrence—the so-called “tropical liver.” However, not infre- 
quently rather extensive liver abscesses are found post-mortem, without 
any appreciable enlargement of the organ. 
Fever—remittent, intermittent, or continuous—is usually present, but 
sometimes the temperature remains normal throughout the course of the 
disease. Septic temperatures are probably always due to mixed infec- 
tions of amoebe and bacteria in the abscesses. ‘Two cases without fever 
at autopsy revealed solitary sterile abscesses of the right lobe. The fever 
is not at all characteristic. Not only may it be of any type, or on the other 
hand entirely absent, but the exclusion of other etiologic agents to which 
its production may be due is not always practicable. I desire to call 
particular attention to the fever which may also be caused by non- 
suppurative trouble of the liver. This is often present, and with 
local inflammatory conditions and adhesions about the hepatic flexure it 
makes a very deceptive picture. Rigors and sweats are usual with septic 
cases. 
The blood count.—The number of the leucocytes and, particularly, their 
differential count, is generally given an undue importance in the symp- 
tomatology of this disease in the Tropics. Neither of these are of very 
great value in diagnosis. The intestinal infection is often responsible 
for a leucocytosis, which, when the associated bacterial infection is such 
as to give rise to acute dysenteric symptoms, may even reach above 
20,000 for days or weeks at a time. Sometimes, with but slight intestinal 
symptoms, a moderate leucocytosis may be due to localized inflammation 
about the hepatic or splenic flexures or the cecum. Frequently, all the 
suspicious symptoms of liver abscess, including the leucocytosis, disappear 
permanently after a few saline purges and large quinine enemas. 
The pain of ameebic abscess is rarely acute and is not so frequently 
referred to the shoulder as it is in other kinds of abscess or in that of 
mixed infection. In the solitary, sterile abscess the pain is more of the 
nature of a general soreness over the liver and tenderness is usually found 
on pressure over its lower border or over the gall bladder. When the 
