136 SUPPURATION. 



ity of the abdominal muscles of the right side, particularly 

 the rectus, which becomes tense and band-like; there is a 

 feeling of weight about the liver, emaciation, prostration 

 diarrhoea, or dysentery. The liver is more or less enlar 

 according to the quantity of matter contained in the sack ; 

 it is no longer uniform, the normal outline of the area of 

 hepatic dulness is altered, and it may bulge upwards, 

 downwards, forwards, or outwards, according to the 

 direction the abscess takes in each case. The contour of 

 this bulging tumour is tense, rounded, and smooth ; the 

 skin shines, and fluctuation can usually be detected in 

 the tumour, which will be more or less prominently felt 

 according to the di-iance of the abscess from the 

 surface. 



Abscess of the liver is gregarious in its course of 

 from tin- ur_:.m ; it may burst into the stomacb and 

 be emptied by vomiting. It mav empty itself into the 

 duodenum, or colon, and pass oil' by the bowels ; it may 

 break through the walls of the abdomen, and escape 

 externally ; it may open into 



away with the urine ; it may pftrfoifete the diuphr 

 and pleura. where it I ;irative pleurisy ; 



or it may open into the lun-j, and discharge itself 

 through the) bronchial tubes, as continued by a well- 

 marked case of a lady wh<> came to consult me from the 

 fenny little town < ; 31 I ves, Huntingdonshire. Wh.-n 

 this happens it is marked by symptoms of its own, viz., 

 by a new set of stetheoscopic :id by the expec- 



toration of a dirty red or brownish matter, which comes 

 up easily sometimes in mouthftlls, without effort on the 

 part of the patient. In another case which I saw in 

 consultation with my friend Dr. G. Sheppard, at Clifton, 



