134 I'he Philippine Journal of Science 1917 



the ribs in front, generally causes smart pain and decided shrinking, the 

 rectus muscle starting up as if to protect the subjacent inflamed parts. 



In our series 34 had symptoms of pain in the right hypochon- 

 drium ; in 1 case in which there was encountered rupture of the 

 abscess into the peritoneal sac, at the time of the operation, the 

 pain was generalized in the abdominal region. In another case 

 in which the location of the abscess was in the right posterior 

 side of the right lobe the pain was in the right side of the chest 

 and in the right shoulder. In a third case the pain was localized 

 in the right iliac region. In this the caecum was the seat of 

 extensive amoebic lesion ; there were multiple abscesses in the 

 right and left Idbes, one of the latter having ruptured and formed 

 a subphrenic abscess in the left hypochondrium. In a fourth 

 case the epigastrium and left hypochondrium were the seat of 

 the pain. The abscess in this case ruptured and formed a sub- 

 phrenic abscess. In one case the onset of the disease started as 

 aching of the long bones. This same patient had his pain in the 

 hepatic region aggravated by ingestion of food. 



One frequent symptom in our cases, particularly among those 

 well advanced, was a peculiar sense of fulness in the right upper 

 quadrant of the abdomen. In cases of this kind, as a rule, the 

 patients came to the hospital for no other complaint but this, 

 and they themselves were aware of the presence of a swelling 

 in the upper part of the right side of the abdomen. 



COUGH 



Even in cases uncomplicated by rupture of the abscess into 

 the lungs or actual involvement of the pleura through a process 

 of continuity, cough plays an important role in the symptom- 

 atology. In abscess of the superior surface of the liver, the 

 irritation on the diaphragm excites a dry, hacking cough. Even 

 in those located in the lower segment of the right lobe, the 

 distension upward may be sufficient to cause coughing. Eight 

 of our cases gave this symptom, three of whom had the abscess in 

 the lower part of the right lobe. 



BLOOD PICTURE 



In cases observed by Manson,(i) Rogers, (22) and Musgrave,(9) 

 no typical blood picture was found. Rogers (22) mentions as 

 high a count as 35,000 and 38,000 leucocytes in two cases, both 

 of the multiple variety. Our case with a count between 25,000 

 and 30,000 leucocytes was also in a multiple type. Musgrave(9) 

 attributes high leucocytosis to intestinal infection. Table IV 

 shows the leucocytosis in our series. 



