AXICGBIC ABSCESS OF THE LIVER. 223 



results are still obtained in cases which subsequently recover completely 

 on ipecacuanha. 



THE STERILITY AS EEGAEDS BACTERIA OF AMCEBIC ABSCESSES OF THE 



LIVER. 



The most important point in regard to treatment is the absence of 

 bacteria from the pus of amoebic abscesses of the liver in the great 

 majority of cases. In the first series in which I examined the pus 

 obtained at the time of the operation, I found two-thirds to be sterile, 

 but this was an underestimate, as the aspiration bottles were not always 

 free from bacteria. In a recent series, in which the pus was received 

 direct from the aspirating canula into a sterile test tube, no less than 

 75 out of 87 consecutive cases, or 86 per cent, were free from bacteria 

 both microscopically and on culture. However, in a few cases very 

 numerous cocci and bacteria are found, occasionally including streptococci. 

 Such cases have a worse prognosis than abscesses containing only the 

 amoeba. The great majority, however, of tropical liver abscesses are 

 solely due to the protozoal organism. 



THE FREQUENCY OF BACTERIAL INFECTION AFTER THE OPEN OPERATION 

 FOR PRIMARILY STERILE AMOEBIC ABSCESSES. 



When examining pus from opened liver abscesses for amoeba, I ob- 

 served that bacteria and cocci were almost invariably present. I there- 

 fore made cultures in a series of cases from the pus obtained in sterile 

 test tubes at the time of opening and again a few days later. In a 

 large number of observations made during the last two years at the 

 Medical College Hospital at Calcutta in no single case did a primarily 

 sterile abscess remain free from infection for as long as three days after 

 being opened and drained in the ordinary way; nor is this surprising 

 when we remember that the sterile, blood-serum-like contents form an 

 ideal culture medium for the organisms, which must inevitably enter 

 from the air at the operation and on subsequent dressings, apart from 

 the frequency with which the copious discharges soak through the cov- 

 erings, and thus allow of contamination. The organisms will commonly 

 be of but slight virulence, but suffice greatly to prolong the period of 

 exhausting discharges and retard the healing of the wound. In support 

 of this contention it may be well to quote the following remarks of Maj. 

 G. C. Spencer, E. A. M. C, professor of military surgery, Eoyal Army 

 Medical Colege. 7 Eegarding the high mortality of the open operation 

 he writes: 



The chief cause of this high mortality, apart from the presence of more than 

 one abscess, or extreme debility of the patient before operation, is undoubtedly 

 infection of the abscess cavity by pyogenic organisms through the open wound. 

 This is extremely difficult to prevent, no matter how much care is taken. . . . 



7 Journ. Roy. Army Med. Corps (1909). 



