AMCEBIO ABSCESS OF THE LIVER. 225 



Summary of cases treated oy aspiration and quinine injection only. 



Abscess not opened - 



Abscess Abscess 



cured. fatal. 



r Cured 16 



Abscess cured, died later of dys- 

 entery 1 



Abscess cured, died later of 

 pneumonia 1 



Died of liver abscess 3 



r Cured 3 



Abscess opened kter-j „• , g 



Total 21 6 



Abscess evacuated through the thoracic wall 25 



Abscess evacuated through the abdominal wall 2 



The site of the evacuation of the pus is important, because I find that 

 the mortality of eases treated by the open operation is but 40 per cent 

 when the incision is through the abdominal wall, but no less than 73 per 

 cent when it is through the thoracic wall. The death rate was but 12 

 per cent in abscesses of the left lobe opened through the epigastrium, 

 owing to their being readily recognized and dealt with while still small. 

 In the above series the death rate among 25 cases evacuated through the 

 chest wall was 24 per cent, or just one-third of the mortality of similar 

 cases treated by the open operation. The three cases in which a fatal 

 result occurred after aspiration and quinine injection alone all had 

 large abscesses, the patients being nearly moribund, and the open opera- 

 tion would almost inevitably have been rapidly fatal. On the other hand, 

 several abscesses containing from 1.5 to 3 liters (3 to 6 pints) of pus were 

 successfully dealt with by my plan, including some in which it was con- 

 sidered that the open operation would have given little or no chance 

 of recovery, one containing 3.3 liters (112 ounces) of pus. In one 

 case the patient died of dysentery three and one-half months after cure 

 of the liver abscess, my suggestion to give ipecacuanha at the time the 

 abscess was first aspirated not having been adopted. In another case no 

 less than 2.5 liters (86 ounces) of pus were aspirated at the first opera- 

 tion, nine days later 532 cubic centimeters (18 ounces) were obtained and 

 seven days later still only 300 cubic centimeters (10 ounces) were evac- 

 uated, quinine being injected at each aspiration. After another eight 

 days only 150 cubic centimeters (5 ounces) of thin bile, without pus, were 

 withdrawn, so no quinine was injected. A few days later the patient 

 died unexpectedly and at post-mortem, left apical pneumococcal consolida- 

 tion of the lung was found, quite independently of the hepatic trouble. 

 The liver abscess was found to have contracted so as to hold only 75 cubic 

 centimeters (2 J ounces) of thin bile with no pus or amoebae, the contents 

 being sterile, as they had been throughout. The fibrous wall was smooth 

 and nearly half an inch in thickness, encystment having taken place. 

 The patient had been given a course of ipecacuanha, and the caecum 



