PREVENTION OF ABSCESS OP THE LIVER. 287 



days under ipecacuanha. This is the class of case in which a large, deep-seated, 

 fibrous walled amoebic abscess of the liver forms very insidiously with irregular 

 intermittent fever; it is commonly treated as malarial, and there are no obvious 

 signs of hepatitis until a very late stage. Two of the above fifteen cases relapsed 

 and returned to the hospital four and seven months later, respectively, with an 

 amoebic abscess of the liver. 



When dysentery is present and complicated by hepatitis, ipecacuanha 

 is advised by Sir Patrick Manson.and other authorities, but at the time 

 the above paper was published I was unable to find any recent writer 

 who recommended large doses of ipecacuanha for hepatitis when ac- 

 companied by dysentery, although several of the older authors in India, 

 especially McClean and Norman Chevers, also strongly urged its use 

 for this purpose. The considerations which led me regularly to adopt 

 this treatment were the finding of dysentery associated with 90 per 

 cent of tropical liver abscesses, and the fact mentioned above, that in 

 many patients dying of liver abscess, without history or symptoms of 

 dysentery, amcebic ulcers are found post-mortem in the upper part of 

 the large bowel. I therefore regarded hepatitis, accompanied by leuco- 

 cytosis, as an indication of the presence of latent amoebic ulceration of 

 the large bowel, which indicated large doses of ipecacuanha for its cure. 

 The results of this treatment, both of those cases mentioned above and 

 of subsequent ones, have been so successful that during the last two 

 years no instance of liver abscess has developed while the patient was 

 in the European General Hospital, Calcutta, although a few patients 

 have been admitted with an abscess already formed. A number of cases 

 of such acute hepatitis in which an abscess was suspected (and in five 

 instances sought for in vain by the aspirating needle) have cleared up 

 entirely under the ipecacuanha treatment. The following three exam- 

 ples, which have occurred during the last two months, will serve to 

 illustrate the value of this method of treatment. 



Case 1. Very acute hepatitis following on dysentery, rapidly cured by ipeca- 

 cuanha. — A European male, aged 25, was admitted for dysentery of six weeks' 

 duration, passing, without pain or straining, about six stools daily containing 

 blood and mucus. He was treated with a castor oil mixture and with creolin 

 enemas and the blood and mucus disappeared from the stools after ten days. 

 Seven days later ( September 11) he began to suffer pain in the hepatic region 

 and in the right shoulder and his temperature, which had previously been 

 slightly subnormal, began to rise. (See chart 1.) The liver dullness was not 

 increased, extending from the sixth rib to the costal margin. The pains con- 

 tinued to be severe, and on the 13th the breath sounds were noted to be weak 

 at the base of the right lung. Morphine was given for the pain, and quinine, 

 10 grains, three times a day for the fever. On the 15th there was profuse 

 sweating, while the liver dullness reached up to the fifth rib. Five leeches over 

 the liver relieved the pain somewhat. On the 16th, the right chest was observed 

 to be moving less than the left, and on the 18th, X rays showed that the 

 diaphragm on the right side was quite motionless, while there appeared to be 

 a slight shadow in the right lobe of the liver. 



