TROPICAL ABSCESS. — There may be one or more; in the latter case there is usually one larger and evidently much older than the others. They may vary in size from a few millimetres in diam eter lip to an orange or even to a child's head. The larger abscesses usually oc cupy the right lobe, being situated, as a rule, at the under surface above the hepatic flexure of the colon or in the dome of the liver (Lafleur). In Waring's statistics of three hundred cases, in 6'2 per cent. there was only a single abscess. The small multiple abscesses are usually superficial. In the smaller abscesses, being more recent, the walls are shreddy and not sharply defined from the con tiguous inflamed liver-substance. Their contents vary from a yellowish gray to a reddish-brown (due to the presence of blood), and often contain shreds of necrotic liver-tissue. In old abscesses the walls are firm, thick, and fibrous. The contents of all the abscesses are chiefly remarkable in the small number leucocytes that are present.
Case of tropical abscess of the liver containing, the amceba coil, in which the discharge from the abscess was examined from (lay to day. On the sixth day after the operation it was found that the leueocytes had very greatly increased, that the ann-chat were rapidly disappear ing, and that, while bacteria had previ ously been absent, there had now ap peared Frankel's pneumococci, strepto cocci, and the colon bacillus. Peyrot and Roger (Rev. de Chin, Feb., '97).
When the abseess is single it is far more frequently found in the right lobe ankl nearer to the upper surface. Waring found that out of 28S eases of tropical abscess 177 N% ere single. The pus from a t rue tropical b.seess sho It complete absence of pyogettie organisms. Osier expresses the opinion that the pus of tropical abscess is quite free from py ogenie bacteria. Maefadyen holds that in tropical abscesses pyogenic organisms are constantly met with, staphylococcus pyogenes aurcus being the commonest, mhile the staphylococcus albtts and streptococcus pyogcnes are often found. C. \V. Windsor (Lancet, Dec. 4, '97).
When the abscess reaches the surface it may rupture and pus escape into the peritoneal cavity, or, adhesions having previously formed, the pus may pene trate in any direction. It may discharge
into the stomach, the intestine, the pelvis of the right kidney, or through the diaphragm into the pleural or peri cardial sac. Adhesion of the lung to the diaphragm usually precedes its advent in this direction, and then the lung is invaded, an abscess forming and dis charging into the bronchi. It may also perforate the thoracic wall and appear beneath the skin.
Prognosis. — Suppurative hepatitis is a grave disease, the mortality being over '60 per cent. In rare cases of single small abscesses and of mild cases of pylephlebitis recovery possibly takes place by absorption or inspissation and calcification of the pus. There is, how ever, room for doubt as to the diagnosis of such cases. Multiple small abscesses are almost necessarily fatal, as they can rarely be evacuated either by natural processes or by surgical intervention. In large abscesses the mortality has been greatly reduced of late by the greater fearlessness and thoroughness with which they are operated on. Operation appears to 5.Tive much better results in the ordi nary septic abscesses than in the amcebic vartety.
Out of 88,416 deaths in ten years, in the city of Mexico, I9S5 were dtte to hepa titis. Symptoms are jaundice, increasing in severity; signs of suppuration; com pression of portal vein; rarely aseites; liver enlarged, but not the spleen. On section, the liver shows many, sometimes even 200, abscesses filled with a white or yellow-green pus. Mejia (La Scut. Med., Aug. 27, '90).
Cases of abscess of the liver usually terminate favorably after rupture into the lungs. T. Glover Lyon (Lancet, Nov. 20, '97).
T reatmen t. — Apart from surgical means, little can be done, beyond re lieving symptoms and maintaining the patient's strength, until the abscess dis charges spontaneously or is accessible to the surgeon. Pain and cough are the chief symptoms to be relieved. In eases of rupture into the bronchi, cough is necessary for the removal of the pus, and should not be interfered with unless excessive.