52 DISEASES DUE TO PROTOZOA 



DIAGNOSIS. 



From Hepatitis by : — 



A definite epigastric swelling compatible with liver abscess, X-ray 

 examination and surgical exploration. 



The trouble is not progressive, but often intermittent. 



Chronic malaria with hepatitis may be troublesome, but the spleen 

 also \\ill be enlarged considerably. 



Tropical liver or febrile congestion is due to diet, alcohol, &c. 



Intermittent hepatic fever due to infective cholangitis gives a history 

 of cholelithiasis. 



Syphilitic gummata by history, \\'assermann and drug reaction. 



Enteric, uncomplicated, shows a leucop^enia. 



Undulant fever, Kala-azar and Tuberculosis the same. 



An excess of mononuclear leucocytes is not common in liver 

 abscess, but there is a constant excess of polymorphs, 75 — 80 per cent. 



Double infections are common. Drugs will sometimes help, as 

 Cjuinine in malaria and emetine in dysenteric abscess. 



The stools should always be examined for amo?bai. 



TERMINATION. 



The abscess may run lis course in from three weeks to three nionihs. 

 It ma\' burst and refill or encyst and give rise to no more symptoms. 

 28 per cent, rupture spontaneously, and usually into the lung, peri- 

 toneum or pleui'cC. There ma}' be 5 — 10 ounces of ]3u.s couglied up in 

 twenty-four hours. Recovery may ensue or sudden h^emoptosis result. 

 The pus coughed up or vomited from the stomach may cease and 

 recover\- take place, or the whole series of symptoms may be repeated. 



When there is spontaneous rupture the possible positions are as 

 follows : — 



Into the abdomen or intestine; here the pus causes the intestines 

 to become matted together, but the pus is sterile. This condition 

 should never be operated upon; the pus will be absorbed. A^^hen into 

 the intestine the pus is passed per anum and usually missed. When it 

 passes into the peritoneum a fatal peritonitis has been caused. 



Into the stomach when the pus is vomited. 



Into the pleura, rare; causes empvema. 



Into the lung, may bog its base, give rise to signs of pleurisy, 

 expectoration of pus and blood; 70 per cent, recover (Groves). 



Into the pericardium, when it is rapidl}' fatal. 



Into the inferior vena cava, rapidly fatal. 



Into the gall-bladder, when the pus is passed ])er anum with possible 

 recovery. 



Externally, by the skin, when the prognosis is at its best. 



