HEPATIC ABSCESS 



233 



so that they are rarely to be found. In the walls of the 

 abscess, in scrapings from the walls, and in the pus dis- 

 charged a few days after the abscess is opened, they are 

 usually present in very large numbers. An abscess may 

 become quiescent and encapsuled or be reduced to a 

 putty-like mass. More commonly they continue to 

 increase in size, and bursting through the liver may extend 

 in the cellular spaces almost anywhere. Frequently they 

 burst into the lungs or intestines and a natural cure 

 results. 



103 

 102 



I 01 



I 00 



99 



FIG. 66. Hepatic Abscess with Irregular Pyrexia. 



The hepatic abscess or tropical liver abscess is usually 

 single, but two or more may be found. The onset is 

 often insidious, and it may be preceded by a more 

 general hepatitis, but as a rule the general hepatitis is not 

 followed by abscess formation. 



The symptoms, once attention is directed to the liver, 

 are usually marked. The liver is enlarged often upwards, 

 so that the upper limit of hepatic dulness is convex. The 

 edge of the liver is usually, but not always, pushed down 

 so that it can be felt below the ribs. The liver is tender, 

 often extremely so, but in other cases firm pressure is 

 required to elicit any signs of pain. The rectus and 

 other abdominal muscles are more rigid on the right 

 side, and pain in a shoulder, usually the right, is a very 

 frequent symptom. The blood usually shows a moderate 

 leucocytosis, and the proportion of polymorphonuclear 



