288 ROGERS. 



Abscess of the liver was diagnosed. However, as there had been 

 recent dysentery, which had not been treated by full doses of ipecacuanha, 

 the physician in charge of the patient (who had over twenty years' 

 experience with Indian diseases) agreed to use the ipecacuanha treat- 

 ment for a short time before operating on the liver abscess, the existence 

 of which he did not doubt. Thirty grains of the drug were given daily 

 from the 19th to the 27th, with the result that the temperature steadily 

 fell as showii in chart 1, and the signs of acute hepatitis simultaneously 

 completely subsided. On the 20th, the pain over the liver and the 

 sweating had both diminished, and the patient slept better. By the 

 21st, the pain had ceased over the liver, although it continued in a 

 slight degree in the right shoulder for another day. On the 23d, the 

 temperature was normal and there was no pain or sweating, and all 

 suspicion of liver abscess had disappeared. The patient was kept in the 

 hospital up to the 22d of November, but had no more signs of dysentery 

 or hepatitis and gained weight steadily. There was no shadow of doubt 

 in the minds of all who watched this patient that the ipecacuanha treat- 

 ment averted suppuration in the liver. 



Case 2. Dysentery followed by hepatitis with temporary recovery; very acute 

 hepatitis success fully treated two and one-half months later with ipecacuanha. — 

 European male, aged 26, admitted August 20, 1907, with a history of dysentery 

 eight months before, followed after three weeks by pain in the epigastrium. On 

 admission there was slight enlargement of the liver with pain over it. Stools 

 loose, but no blood or mucus; intermittent fever rising to 101° or 102° F. in 

 the evenings. The diaphragm moved well, and there was only a slight increase 

 of the leucocytes, with but 65 per cent of polynuclears. The symptoms of 

 hepatitis subsided in three weeks under salines and quinine, and the patient left 

 the hospital apparently well. He returned two and a half months later 



(November 26) having had fever every evening for the previous month and a 

 half, with rigors at times and intermittent, sharp pain over the liver. His 

 bowels had been constipated. He was now weak and thin. There was slight 

 bulging in the hepatic region, without marked tenderness. The breath sounds at 

 the right base were diminished, with a decrease of vocal fremitus and vocal 

 resonance. The liver dullness extended from the fifth space to 3 inches below 

 the costal margin in the nipple line. No oedema was present. The spleen was not 

 enlarged. Under X rays the right half of the diaphragm was observed to be 

 2 inches higher than the left and scarcely moved, even with deep respiration, 

 but there was no shadow. A blood count showed red corpuscles 3,570,000, white 



15.000, ratio of white to red, 1 to 236; polynuclears 77, lymphocytes 23; large 

 mononuclears 9 and eosinophils 1 per cent. 



Because of the acuteness of the symptoms and the fullness in the 

 liepatic region, liver abscess was suspected, but it was determined to try 

 the ipecacuanha treatment before operating, so 30 grains were given on 

 the evening of the 27th, and 40 grains on the following four evenings. 

 On the 28th and 29th the hepatic pain was distinctly less, and the 

 patient could turn over on his right side, which he could not do before. 

 On the 30th there was no pain or tenderness over the liver. On the 2nd 



