224 ROGERS. 



The great majority of amoebic abscesses are sterile when first opened, and every 

 surgeon with Indian experience is familiar with the usual course of fatal cases. 

 The patient does well for the first few days after operation, then infection oc- 

 curs, the temperature goes up again, and death from septic poisoning slowly but 

 surely follows. 



THE TREATMENT OF A STERILE AMCEBIC ABSCESS OF THE LIVER BY RE- 

 PEATED ASPIRATIONS AND INJECTIONS OF QUININE INTO 

 THE CAVITY WITHOUT DRAINAGE. 



In abscesses due to the ordinary pyogenic bacteria there is no differ- 

 ence of opinion as to the necessity of early opening and drainage. A 

 similar line of treatment in large, cold tubercular abscesses, however, 

 has sometimes been followed by a disastrous secondary infection. Trop- 

 ical abscesses of the liver for many years past have been almost uni- 

 versally treated by free incision and open drainage, exactly as in ordinary 

 septic abscesses due to bacteria. The results can not be said to be 

 brilliant, for in the Calcutta hospitals the mortality among several hun- 

 dred cases, treated by very experienced surgeons during the past thirteen 

 years, has been 60 per cent. Now that we know that this form of abscess 

 is caused by a protozoal organism, and the vast majority of them are free 

 from bacteria when first opened, although infection almost invariably 

 follows their free incision, it is worth considering if some simpler and 

 safer method of treating the disease can not be found. On ascertaining 

 that tropical liver abscesses always contain arncebse and are usually pri- 

 marily sterile, I set to work to test the effect of drugs on the causative 

 protozoa in the walls of liver abscesses, post-mortem, and in 1902 recorded 

 the fact that a 1 to 500 solution of quinine would readily destroy the 

 amoebae under these conditions. I therefore suggested the treatment of 

 bacterially sterile liver abscesses by withdrawal of as much pus as possible 

 through an aspirating needle and the injection of 1.30 grams (2 grains) of 

 quinine in solution into the cavity, no incision or drainage being used. In 

 1906 I reported with Capt. B. P. AVilson, I. M. S., 8 two cases successfully 

 treated by this plan, since which several surgeons have recorded similar 

 results. Major Spencer early in 1909 published several, in one of which 

 three aspirations and injections were necessary, while in the other two a 

 single operation sufficed, and he advised the adoption of my plan in all 

 cases, as even if it fails no harm is done, and the patient may be in a 

 better condition to stand the more serious open operation. 



During the past year Maj. F. O'Kinealy and C. E. Stevens have kindly 

 given my method a prolonged trial at the Calcutta Medical College 

 Hospital with most encouraging results. The latter surgeon will shortly 

 publish his own conclusions, so I will only here tabulate the results of 

 the cases I have been able to watch in the several Calcutta ' hospitals 

 during the last few years. 



8 Brit. Med. Journ. (1906) 1, 1397. 



