1912 DISEASES OF THE LIVER AND PANCREAS 



the arched ' cupola-like ' curve of the upper aspect of the liver, as 

 seen by radioscopy. The early stage, called by Rogers the ' presup- 

 purative stage,' is of the utmost importance; for if it can be recog- 

 nized and appropriate treatment applied, the disease may "^e 

 stopped in a certain number of cases. If, however, this is not 

 done, rigors may take place, and the fever usually becomes more 

 severe, and a typical hectic temperature with night-sweats may 

 ensue; while the patient complains of a dragging sensation on the 

 right side, pain under the right shoulder-blade and in the right 

 shoulder. This latter is a referred pain, due to the fact that the 

 phrenic nerve arises from the fourth cervical nerve-root, the fibres 

 of which supply the skin of the shoulder. 



T.'ME 

 105' 



M £ 



M 









1 £ 







£ M E 



M 



r 



n\c 



r. z 





t n 





£ f 



1 £ 





C 



W 





•7 C 





e: M 



f 







M 



~ M £ 



M 



£ 





E 1 



1 E 



M 





|— 4/° 



t m' 



k '02* 



H 























o — 



fp- 

















■ ■t 

 -t 



r 



J 

 i. 



§- 

 s - 



L 



a 

































: 1 



-39' 



I 

 1 



100' 



99' 

 98' 

 97' 





H 











V 











^- 













































4 





~C 



o. 



c- 



I f' 



^38° 

 -37' 



Fig. 776. — The Temperature Chart of a Case of Abscess of the Liver. 



A patient with an abscess of the liver often possesses a most 

 typical facies. He lies on his back, with his legs drawn up; his face 

 is drawn, and of a pale yellow colour, and the ocular conjunctiva 

 possesses a peculiar bluey-whitish colour. It is said that sometimes 

 the right pupil is dilated, but in our experience this is not a constant 

 symptom. Generally he is emaciated, and deep inspiration is pain- 

 ful; hence the breathing is costal in character, and often there is a 

 slight cough. The hands and feet are often cold and clammy to 

 the touch. 



On inspecting the abdomen and chest, the right hypochondrium 

 will be noticed to be bulging, while the liver is enlarged and tender. 

 On palpating the front of the abdomen, the right rectus muscle may 

 be felt to become suddenly rigid — a most characteristic sign- — ^while 

 the left is not affected. On percussion the liver is found to be 

 enlarged, and pain may be produced by pressure in the epigastrium 

 or over an intercostal space. These painful spots are of importance 

 in localizing the site of the abscess. On listening over the lower 



