PREVENTION OP ABSCESS OP THE LIVER. 289 



of December his temperature remained normal for the first time, and a 

 steady convalescence followed, the liver receding until it was only just 

 felt beneath the costal margin. The ipecacuanha was continued in 

 30-grain doses at increasing intervals up to January 5, 1908, in order 

 to guard against the possibility of a relapse, and the patient left the 

 hospital apparently quite well on January 9. The rapid lessening of 

 the pain, followed by the decline of the fever and decrease in the 

 enlargement of the liver under the ipecacuanha was most striking in 

 this case, and indicated that the treatment prevented suppuration of 

 the liver. 



Case 3. Hepatitis, history or symptoms of dysentery rapidly subsiding under 

 ipecacuanha treatment . — European male, aged 51, admitted on December 3, 1907, 

 for fever. He had been ill for two weeks with fever and pain in the right 

 hypochondrium, with nausea and loss of appetite. No rigors, but the patient felt 

 chilly at times, with sweats at night. The bowels were constipated. The liver 

 extended 1 inch below the costal margin, and was very tender. Other organs 

 normal. A blood count on the 11th showed 4,670,000 red corpuscles, 12,875 white, 

 ratio of white to red 1 to 363, polynuclears 81, lymphocytes 12, large mononuclears 

 6, and eosinophiles 1 per cent. 



Ipecacuanha was commenced on the 7th of December, 30 grains being- 

 given each evening. Two days later the temperature began to decline 

 and reached normal on the 11th, after which there was only one rise on 

 the 13th accompanied by a rigor, being possibly malarial in nature. On 

 the 17th the liver had become reduced in size, being only just felt below 

 the ribs, and the patient left the hospital apparently quite well on the 

 22d of December. (See chart 3.) This is an example of the less acute 

 form of hepatitis, which drifts' insidiously on into suppuration after 

 weeks of intermittent fever. It is only one step further to the class 

 already mentioned, in which there is no pain or tenderness over the 

 liver, and the leucocytosis alone raises a suspicion as to the true nature 

 of the case, which suspicion is confirmed by the chronic fever rapidly 

 yielding to large doses of ipecacuanha. 



METHODS OF GIVING IPECACUANHA. 



In giving large doses of ipecacuanha in amoebic dysentery and hepa- 

 titis, precautions must be taken to avoid vomiting, especially if it is pos- 

 sible that an abscess of the liver has already formed. The usual method 

 is to give either tincture of opium or chloral hydrate some twenty minutes 

 before the powdered ipecacuanha, no food or drink being given for 

 several hours before and after the dose, which is best administered once 

 a clay in the evening. Eecently I have had the drug put up in quantities 

 of 5 grains in keratinized capsules, which ' are not dissolved until they 

 reach the small intestines, and this has worked very well, no antecedent 

 sedative being required. Dr. E. B. Grubbs, of the United States Army, 

 has recently informed me that the same effect is produced by coating 



