8 



was then made to locate the abscess through aspiration of the various 

 portions of the liver with a long needle. This, however, failed, and 

 the liver was stitched to the abdominal wall and the patient returned 

 to the ward. 



On March 2 and 3 there were no bowel movements, but on the 

 4th the bowels moved four times during the day. The stools were 

 thin and yellow, but only the first contained a little blood. On 

 March o there were three bowel movements at night. These 

 were yellow, formed, and contained no blood. It should be men- 

 tioned that the local treatment with enemata had been discon- 

 tinued since February 26. The fever still continued. On March 6 

 there were six bowel movements of greenish-yellow color containing 

 some milk curds and other undigested food. 



The patient was seen again by the author on March 7. He 

 then complained of pain in the region of the operation wound. 

 While asleep there was considerable muttering and marked twitching 

 of the hands. The temperature was 103.4°, the pulse 110. There 

 was very slight jaundice of the conjunctivae. The abdomen was 

 slightly distended. A blood count showed 18,000 leucocytes. There 

 were three bowel movements on this date, one containing a little 

 blood and mucus. A microscopical examination showed many 

 amoebae, some inclosing red blood cells. A diagnosis of typhoid 

 fever was suggested by one of the staff in consultation and was par- 

 ticularly urged, as the abscess had not been located, but arguing 

 against such a diagnosis were the facts that the spleen was not pal- 

 pable and there were no rose spots. ^Moreover the serum failed in the 

 afternoon of this day to give an agglutinative reaction with Bacillus 

 typhosus. It was suggested that the local treatment with quinine 

 enemata be resumed and that another attempt be made to locate 

 the abscess. Accordingly aspiration was again performed by the 

 surgical staff through the abdominal wound, but still unsuccessfully. 

 On March 8 there were two bowel movements after the enema of 

 quinine solution, and on the 9th four. The movements were dark 

 and thin, but macroscopically contained no blood. The temperature 

 ranged between 102° and 103.6°. 



On March 10, at 2.45 a. m., a large hemorrhage of about 500 

 cubic centimeters of fresh-looking blood and containing four or 

 five large clots were passed from the rectum. The pulse shortly 

 after counted 140. The temperature was unfortunately not taken 

 until two hours later, when it registered 102.6°. The pulse then 



