286 ROGEltS. 



In a second paper, in 1903, 4 I gave an account of amoebic dysentery 

 in India, illustrated by a colored plate, and discussed the mode of 

 formation of amoebic abscess of the liver, and in 1905, 5 I dealt with the 

 value of leucocytosis in the early diagnosis of amoebic abscess, and 

 pointed out that, although occasionally an attack of acute hepatitis 

 with leucocytosis may clear up without suppuration occurring, yet if 

 such cases are followed up, sooner or later an abscess of the liver nearly 

 always forms. I also narrated a case of acute hepatitis with leucocytosis, 

 which cleared up under large doses of ipecacuanha. In 1906 6 I pub- 

 lished an article on two cases of amoebic abscess of the liver successfully 

 treated by aspiration and injection of the soluble acid quinine hydro- 

 chloride, without drainage, having found that the amoebae in thick liver 

 abscess pus could readily be killed by that drug in a strength of from 1 

 in 100 to 1 in 500, a method which has since proved effective in other 

 hands, especially in early, deep-seated abscesses although it fails in manjr 

 more advanced cases. 



While on the lookout for the early stages of the disease for this line of 

 treatment, I met with a number of cases of fever with leucocytosis and 

 symptoms of acute hepatitis, in some of which aspiration failed to reveal 

 any abscess; they yielded, however, very rapidly to full doses of ipeca- 

 cuanha, thus showing that the increase of the leucocytes takes place 

 before actual suppuration has set in and sometimes many days earlier. 

 Last year (1907) 7 I published a series of such cases which were rapidly 

 cut short in the presuppurative stage by the ipecacuanha treatment, 

 which may be briefly summarized as follows : 



Fifteen eases were met with during twelve months in the Calcxvtta European 

 General Hospital. In only three was there a clear history of dysentery or 

 symptoms of it while' in hospital, while these lost their fever and hepatitis 

 after two to four days treatment with ipecacuanha, although they had previously 

 suffered from fever for fifteen, thirty-four, and forty-one days respectively, and 

 one had been aspirated for liver abscess with a negative result. In three more 

 cases of acute hepatitis, without dysentery, not treated by ipecacuanha, the fever 

 only subsided after from thirty-four to forty-nine days. In five similar cases 

 treated with ipecacuanha the fever subsided in from one to six days, although 

 it had previously persisted for from thirteen to fifty days, one patient having 

 been aspirated with a negative result. Lastly, there were three cases of fever 

 with no signs of either dysentery or hepatitis, other than very slight painless 

 enlargement of the liver, but with leucocytosis of the same type as in the other 

 cases, namely without very marked increase of the proportion of the polynuclears 

 (usually from 70 to 80 per cent.) They had suffered from fever for thirty-five, 

 forty-five, and fifty-three days, respectively, which ceased in from two to fifteen 



* Brit. Med. Journ. (1903), 1, 1315. 

 s Ibid. (1905), 2, 1291. 

 "Ibid. (1906), 1, 1397. 



''Practitioner (1907), 78, 766; Fevers in the Tropics (Oxford Medical 

 Publications) (190S). 



