Sessional_Paper_1906 — Page 450

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any time.

The advent of the ill-defined swelling in the abdomen with emphysemu suggested the possibility of an abscess due to ruptured duodenal ulcer, the abscess cavity being shut off by adhesions. Nothing was found post-mortem to account for this peculiar crackling which I have never seen or heard of before. The inspissation of such a large abscess is most unusual, if not unique and would have made it impossible to treat the case, if it had been diagnosed, as the pus was quite solid. Presumably the ambæ reached the liver without first attacking the large intestine a most interesting fact.

Femoral Aneurism. Intraperitoneal Ligature of External Iliac.

Incision of Sac. Recovery.

A Chinese coolie from South Africa, aged 56, was admitted on August 6th with a very large swelling over the right femoral artery. The skin over the tumour was very red and thin threatening at any moment to rupture. Expansile pulsa- tion was easily made out and a soft blowing murmur was heard all over the

tumour.

The following day under chloroform, as it was found difficult if not danger- ons to tie the artery above Poupart's ligament, an incision was made in the right semilunar line, the intestines held out of the way and the external iliac easily tied with silk when the pulsation at once ceased. The abdominal incision was closed with six silk sutures.

Owing to the constant pain complained of over the sac 3 days after the patient was again placed under chloroform the sac freely incised and the recent blood clot herned out. Part of the sac only, was dissected out and the hole plugged with glutol.

On the 5th day as the incision had healed the stitches were removed but next day the patient sat up in bed and a violent fit of coughing opened up the wounds. Under chloroforin the intestines were at once returned and the incision closed again with silk sutures.

The after progress of the case was most satisfactory the incision healing well and firmly and the sac shelling out under glutol dressings.. The patient left in due course for his home in North China,

Remarks. This was an extraordinary large aneurism being about double the size of an orange.. No history was obtainable as to injury and the patient stated that he first noticed it six mouths previously.

Short Notes on Cases of Liver Abscess.

As these cases are of great interest I think it as well to append short notes of each case.

1. European male, aged 49, from Philipine Islands. Ill for two months. No previous dysentery or bowel complaint. Liver much enlarged and painful. Rigors and high fever. Stool examined but showed no amabæ or other abnormality. Blood count gave red cells 3,400,000, white cells 13,000, i.e., 1 to 269. Large abscess cavity opened 48 hours after admission. Fatal. Post-mortem, only a single large abscess found teeming with amœbæ, no signs of old or recent ulceration in the intestines.

2. Chinese male aged 40. Ill for a month. Liver increased in size. Blood count red cells 4,160,000, white cells 8,000, ¿.e., 1 to 520. Liver aspirated with negative results. Fatal. Post-nortern, large abscess full of inspissated pus with small cavity behind containing liquid purulent contents. Both abscesses teeming with amabæ. No signs of old or recent dysentery.

3. European male, aged 36, resident in the Colony. Il for 2 years on and off with dysentery. Patient very ill on adinission with enormously enlarged liver and dysentery stools full of ainœba. Abscess at once opened but case ended fatally. Post-mortem, a large abscess found on liver, smears from which showed numerous amabæ. Large intestine much thickened and covered with small super- ficial ulcers smears from which also showed numerous motile amœbæ. No blood count inade.

4. European aged 39, resident in the Colony. Admitted with dysentery and amabæ in the stools. No malaria, sings of hepatitis supervened. Blood count gave red cells 3,861,000, white cells 9,333, i.e., 1 to 413. Abscess located and opened. Pus full of amabæ. Patient still in hospital.

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