290 ROGERS. 



ipecacuanha pills with molted salol, but I have not yet had an opportunity 

 of trying this method. From 30 to 60 grain doses of the drug have 

 been used, but the smaller quantity appears to be sufficient. It should 

 be continued for at least two weeks at increasing intervals, as two of my 

 earlier cases, in which the ipecacuanha was discontinued as soon as the 

 temperature fell, subsequently relapsed some months later, presumably 

 owing to the latent amoebic ulcers not having been completely cured. 



DURATION OF THE PRESUPPURATIVE STAGE OP AMffiBIC HEPATITIS. 



There remains to be considered a very important question. What is 

 the usual duration of the presuppurative stage of amcebic hepatitis, 

 during which the ipecacuanha treatment will avert the formation of an 

 abscess in the liver? An examination of my records during the last 

 seven years has furnished the following data: Out of fifty-three native 

 patients admitted to the hospital with liver abscess, often bulging through 

 the thoracic or abdominal wall, 51 per cent gave a history of over two 

 months' illness, and an additional 38 per cent, one of between one and 

 two months; 9 per cent from two weeks to a month, and only 2 per cent 

 under two weeks. Among 26 cases in Europeans there had been fever 

 or hepatitis for over one month in 50 per cent, from two weeks to a 

 month in 34.6, and of less than two weeks in only 13.4 per cent (4 cases 

 of 9, 11, 7, 13 days respectively). It is clear from these figures that 

 in the vast majority of instances there is ample time for the diagnosis . 

 by the blood examinations and for the ipecacuanha treatment during the 

 presuppurative stage. Very rarely multiple abscesses may develop within 

 a few days with extreme acuteness, yet I believe it is not too much to say 

 that over 90 per cent of amcebic abscesses of the liver can and should 

 be prevented by the methods described in this communication, and 

 thus one of the greatest scourges of some tropical countries may be 

 conquered 



