132 ^^6 Philippine Journal of Science 1917 



secondary infection, the pus is ba'cteriologically sterile. With 

 the presence of bacteria, the color and consistency differ entirely. 

 In 25 cases in our series the pus was examined and amoebae 

 were identified in 9 cases. Bacillus subtilis was present in one 

 case, staphylococci in another ; in a third case colon bacillus was 

 present as well as Oxyuris vermicularis. Our findings in pure 

 amoebic cases as to the character of the pus correspond very well 

 with the observations of workers in other countries. 



ADHESIONS 



These occur in cases where the abscess is near the surface of 

 the liver. We had one case in which there were so many ad- 

 hesions around the abscess that during an attempt to separate 

 them the abscess ruptured. In another case the abscess was on 

 the anterior superior surface of the liver, and there were many 

 recently formed adhesions around it, the abscess having ruptured 

 before operation. In spite of the adhesions in this particular 

 case, there was marked secondary peritoneal infection. 



SYMPTOMS 

 GENERAL CONSIDERATIONS 



All observers agree that there are no fixed symptoms which 

 make up a classical clinical picture of amoebic liver abscess. It 

 is true enough that there are certain cases which we can correctly 

 diagnose before operation, but the range of variation of the many 

 clinical signs is so great that experience has compelled us to be 

 more conservative in ascribing the symptoms to liver abscess 

 only. Certain abscesses give typical symptoms of fever, chills, 

 pain, and enlargement of the liver and yet many cases of the 

 large variety show no symptoins whatsoever. 



FEVER 



The fever, just as the symptoms, varies in degree. Four of 

 our cases had perfectly normal temperature ; 6 cases had fever 

 ranging from 37° to 38° C. at the time of admission, but twenty- 

 four hours after the patients had been put to bed and proper 

 dieting instituted, the temperature came down to normal. 

 Twelve cases presented an irregular temperature curve, rarely 

 reaching, however, 39.5° C; 7, with temperature of the remittent 

 type with normal or slightly subnormal in the morning and 37° 

 to 38° C. in the evening; 2 cases with septic temperature; 2 

 cases with subnormal, 1 remittent and 1 with a continued fever 

 between 37° and 38° C. until twenty-four hours after operation. 

 Musgrave(9) states that there is no characteristic fever in liver 



