222 KOGERS. 



SUPPUKATIVE AMCEBIC HEPATITIS. 



Diagnosis. — Now that I have shown that leucocytosis of a marked 

 degree occurs in the readily curable presuppurative stage of amoebic hepa- 

 titis, it is clear that we can obtain no aid from an increase of the leucocytes 

 as a sign of the actual formation of an abscess in the liver in a doubtful 

 case. Complete fixation of the diaphragm and rarely an increased 

 density of the liver shadow, as seen with the X rays, may be present in 

 cases which clear up under ipecacuanha. I have also seen a local 

 swelling in the epigastrium and even oedema over the ribs in cases rapidly 

 cured in this way. In fact, I know of no certain symptom of the for- 

 mation of pus within the liver except a fluctuating swelling in the 

 hepatic region. It is for this reason that exploratory puncture is so 

 often performed in acute hepatitis for the confirmation of suspected 

 liver abscess, only too often with a negative result; nor is this opera- 

 tion the harmless procedure it is frequently represented to be. -I know 

 of several fatalities from hemorrhage into the abdominal cavity re- 

 sulting from it, while Lieutenant-Colonel Hatch, I. M. S.,° has done a 

 public service by having had the courage to publish a series of six such 

 cases in his experience, occurring in the Bombay Presidency. Moreover, 

 this disaster is most likely to occur in cases in which no abscess is found, 

 in some of which it was* proved post-mortem that no pus had formed in 

 the liver. It is especially in the acutely congestive presuppurative stage 

 that serious bleeding follows exploratory puncture of the liver; yet it is 

 often most important to detect and deal with an abscess in the liver 

 before it has clearly revealed itself by its large size or through implicat- 

 ing surrounding organs, and hitherto the needle was the only means of 

 deciding if suppuration had taken place or not. Fortunately, we are now 

 in possession of a much simpler and safer plan, for if the disease is 

 still in the presuppurative stage the fever, pain, and liver enlargement 

 all rapidly yield to ipecacuanha, which is as much a specific for amoebic 

 hepatitis in the early stage as quinine is for malaria. No harm results 

 from a few days' delay if pus has already formed, while the danger of 

 further abscess formation will be greatly reduced by the drug treatment. 

 If, however, fever continues for a week or more without material diminu- 

 tion, and especially if the local pain remains, an abscess has probably * 

 already formed and exploratory puncture may now be performed with 

 much less risk, as the general congestion of the liver will have been 

 greatly lessened by the ipecacuanha. Since this rule has been followed 

 in the Calcutta European Hospital negative exploratory punctures for 

 liver abscess have become as rare as formerly they were frequent. In the 

 Medical College Hospital explorations are still performed by the surgeons 

 in doubtful cases, without a previous trial of ipecacuanha, and negative 



8 Indian Med. Gaz. ( 1898) . 



