AMCEBIC ABSCESS 51 



pus, with red blood here and yellow mucus there, while a little green 

 bile may add to the variety of colour. The pus is not readily taken up 

 by the dressing and has a peculiar smell. The pus is usually sterile. 

 Under the microscope can be seen red blood cells, broken down 

 liver tissue, large, granular, pigmented, spherical cells, leucocytes, 

 debris, oil globules, h^ematoidin crystals, amceb^e, and very rarely 

 pyogenic cocci. Amoebae are best seen four days after the operation 

 coming through the drainage tube. They persist until the abscess has 

 healed (Manson). The necrosis is thought to be due to the toxic action 

 of the E. tetragena. 



SYMPTOMATOLOGY. 



There is nearly always a history of dysentery, but amoebic 

 diarrhoea is not uncommon. Rogers states that 30 per cent, of his 

 cases gave no history of dysentery, 14 per cent, of no bowel disturb- 

 ance, but 98 per cent, of them revealed ulceration and scarring post 

 mortem. 



There is chill, headache, foul tongue, loss of appetite, languor and 

 depression. Weight and fulness in the right hypochondrium, sharp 

 stabbing pain often affecting the right shoulder and arm from the 

 phrenic nerve and the fourth cervical to the brachial plexus. 



Cough, according to the extent of the irritation of the diaphragm 

 and pleun-e; there is often dyspnoea due to the base of the lung being 

 affected. 



Sweats at night, earthy tint of skin, emaciation. 



Breathing rapid and shallow, chiefly on the right side, and thoracic. 



Pulse, 80 — 100; hands and feet cold. Rigors sometimes. 



Right rectus rigid; the left is not so. Pain on palpation. 



The whole right side bulges, and the intercostal spaces are 

 obliterated. 



The liver dulness is higher than normal and arched abDve. It is 

 also lower than normal. 



Pleuritic friction may be heard. 



The body is often bent to the right side and the right leg flexed. 



Cutaneous oedema of the chest wall is common, but oedema of the 

 feet and ascites are rare. 



Vomiting may occur from gastric irritation due to pressure. 



Occasionally one sees varicosity of the epigastric and h^emorrhoidal 

 veins. 



Jaundice is not constant, and is but slight. 



There is leucocytosis, the polymorphs going up to 74 — 87 per cent. 



Basal pneumonia of the right lung alone in a dysenterv patient 

 should arouse suspicions. 



