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abscess is of the sub-diaphragmatic type, pain is usually increased by a 
change of position, particularly by lying on the left side or by standing. 
In one case this dull, sore pain on standing or lying on the left side was 
the only subjective symptom of a subdiaphragmatic abscess; and this 
symptom disappeared before the diagnosis was made as a result of the 
perforation by the abscess into the lung. The local pains are most pro- 
nounced in superficial abscesses accompanied by perihepatitis, and the 
radiating ones in deeper disturbances and in septic conditions. As has 
already been mentioned, intestinal infection with inflammation and adhe- 
sions about the upper flexure of the colon may, in these instances, be 
deceptive. 
The respiratory system.—Where abscesses rupture into the lung or 
pleura disturbances occur in the respiratory system. This is also the case 
when there is inflammation between the liver and diaphragm, or between 
the diaphragmatic and parietal pleure, a condition which sometimes occurs 
without actual extension of the liver abscess into the chest. No difficulty 
will be found in diagnosing an amcebic empyema. The lung is frequently 
the seat of lesions caused by rupture of the liver abscess and the diagnosis 
can be made by finding the parasites in the sputum. 
Jaundice of a marked type is rare in solitary abscesses, and not very 
frequent in multiple ones. A slight subichteric tinge is quite common, 
but this is equally so in the non-suppurative hepatitis often associated 
with intestinal diseases. Except in septic conditions, there are no 
stomach symptoms of importance. There may or may not be nausea and 
there rarely is vomiting. One very important point which has not been 
properly emphasized is the influence which liver abscesses frequently 
exert on the intestinal symptoms. An increase in the number of the 
bowel movements during the development of abscesses is, to say the 
least, sufficiently common to be suggestive, and the removal of the liver 
pus by operation is nearly always followed by a temporary improvement 
in the number and character of the bowel movements. 
Summary.—The symptoms of amcebic liver abscess vary greatly and 
may entirely be absent for long periods of time—sometimes for years. 
The diagnosis of the disease depends more upon the general picture, after 
excluding other diseases, than upon any system of direct examination. 
In the Tropics, the symptoms of an ameebic liver abscess may largely 
be the result of other conditions and diseases present at the time, and 
therefore these symptoms sometimes exist without liver abscess. In all 
cases the diagnosis should be confirmed by exploratory puncture and it 
must not be forgotten that even by this means a large abscess may not 
be located after very persistent use of the exploring needle. The diagnosis 
during life or before perforation is sometimes impossible and this is 
particularly true when the abscess is situated in the smaller lobes of the 
liver and in other inaccessible places. Except to differentiate between 
a situation in the right or left lobe, exactly to locate the abscess is 
