Sessional_Paper_1903 — Page 346

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APPENDIX.

CASE OF ABSCESS IN LEFT LOBE OF LIVER.-OPERATION, DRAINAGE, RECOVERY. W.W., Clerk, English, age 30, residing in Hongkong, was admitted on February 3rd, 1902. He stated that he been feeling unwell for 10 or 12 days, bowels constipated, vomiting more or less continuous, no history of dysentery. His temperature was 102° F., his tongue very much furred, breath offensive, hepatic dulness slightly increased, the upper part of the abdomen was semewhat distended. Urine S. G. 1,027, reaction alkaline, free from albumen and sugar. Patient was placed on low diet with milk O. ii daily, Carlsbad Salts şi in water each morning, and Calomel gr. i in powder given at bed time. Bowels were freely opened the following day, blood examined for malaria, but no parasites were found. On February 8th his temperature was normal and there had been no vomiting for several days. Patient improved steadily and on the 14th was able to take a walk in the garden. Two days afterwards his temperature rose steadily to 103° F. and the abdominal pain returned. On the 18th he complained of distinct pain in epigastrium, worse on pressure, the left lobe of the liver was slightly enlarged, there was slight cough, and pain in epigastrium on coughing. Spleen was enlarged, and a pleuritic rub was detected at the left base in the axillary line. The following day he vomited once.

On the 21st February, chloroform was administered, Potain's aspirator used, and the left lobe of the liver explored. No pus was found. The swelling at the upper part of the abdomen appeared less when patient was under chloroform.

He had an attack of bilious vomiting on the 23rd instant and three days later chloroform was again administered and an abscess found in left lobe of the liver. It was freely opened, a silver tube inserted, but very little pus came away. The tube was removed on the 28th instant as it was supposed to be blocked, dis- charge slight. On March 1st the opening leading to the abscess cavity was well dilated with a long pair of Sinus forceps, about seven ounces of pus came away and a long silver tube was re-inserted. Temperature kept normal, the abscess cavity gradually closed. Tube was removed on the 15th and the cavity packed with gauze. Patient was discharged from Hospital quite recovered on April 11th.

CASE OF HEPATIC ABSCESS BURSTING INTO THE LUNG AND BOWEL.-RECOVERY.

R.W.H., American sailor, age 31 years, was admitted on July 20th, 1902, with a history of dysentery since the previous December. Temp. 102° on admis- sion, liver dulness very much increased, bulging of the lower intercostal spaces, and he was spitting up "brick red" pus. A pleuritic rub was noticed at the lower half of the right lung posteriorly, and a peculiar catch at the end of inspiration over the base. The sclerotic was a pearly hue. His bowels had been moved twelve times in the previous eight hours. The stool was watery, offensive, and dysenteric in type, free from blood. He was placed on milk diet with chicken broth, custard pudding, etc., and a powder containing Salol gr. v, Pulv. Ipecac. Co gr. iv given every 4 hours.

The sputum on examination showed broken down liver tissue, cells altered, with red blood corpuscles, much debris, and the amoeba coli. Tubercle bacilli were absent and various forms of cocci present. Urine free from albumen and sugar, acid reaction. Temperature for the next four days was of a hectic type reaching 102° F. in the evening, and dropping to 99° F. towards morning. Sputum continued copious, cough severe, and the liver dulness was considerably diminished. Diarrhea still continued, from 7 to 20 stools in 24 hours, placed on Mist. Cret. et Bel. every 4 hours, with fair result, about 8 stools on an average being passed in the 24 hours.

On August 1st it was decided to administer chloroform and try to locate the abscess cavity and drain.

The liver was punctured in several places without result, and Potain's aspirator being used.

On May 5th his temperature dropped to normal, cough and sputum were less and Pulv. Ipecac Ver. gr. xxx was given to check the diarrhea.

The patient passed a quantity of liver abscess pus in a stool on August 7th, up to this date he had lost 8 lbs. since his admission to Hospital. On the 20th patient was again placed on chalk and Bel. mixture. Stools averaged two to three per diem, cough had almost gone, little or no sputum, and temperature kept normal.