im.ia. 307 



Capt. W. J. Niblock says the disease is not so frequent 

 as is generally supposed. ( Notes on operations for ab- 

 scess of the liver, ascites, and gall stone. J ml inn Medi- 

 cal Gazette, November, 1903.) In looking through the 

 reports of the Madras General Hospital, he found that, 

 .lining the ten years, 1893-1902 inclusive, only 154 

 cases were operated on, and during the last three years 

 the average annual admissions were at the rate of 

 63,591. Of the 154 cases recorded, 21 were shown to 

 be multiple, all of whom died. There were 53 deaths 

 among the 133 other cases, several of which were, how- 

 ever, probably multiple, as some of the surgeons who 

 performed the operations made no distinction between 

 single and multiple abscesses in their records. Capt. 

 Mblock reports the result of 29 cases of abscess of the 

 liver operated on by himself from March 25, 1899, to 

 Sept. 21, 1903. All the patients were males, their ages 

 ranging between 24 and 70. The racial distribution 

 was as follows : Hindu, 19 ; Eurasian, 3 ; European, 5 ; 

 Mussulman, 2. Out of the 29 cases, 5 were multiple, 

 all of whom died. Among the remaining 24 there were 

 G deaths, that is, the mortality was 25 per cent. All of 

 the abscesses containing less than 20 ounces of pus at 

 the time of operation recovered. In the treatment of 

 this affection the author of the paper emphasizes the 

 importance of a preliminary exploration of the liver by 

 means of a long needle and syringe. 



His directions for exploring the liver are as follows: 

 "If a distinct prominence be felt or seen, the needle is 

 first introduced at that situation. Where no such prom- 

 inence exists, the needle is usually introduced into the 

 liver through the ninth or tenth intercostal space. 

 After the liver has been pierced, the piston of the 

 syringe is drawn back for an inch or so, leaving a 

 vacuum. Should pus now enter the syringe, the latter 

 is detached, leaving the needle sticking in the liver to 

 act as a guide. If no pus be found, the needle is gently 

 pushed upward, inward and slightly backward, this 



