ABSCESS OF THE LIVER.
Dr. Theodore Dunham presented a boy, five years old, who had enjoyed perfect health until last August, when he began to complain of loss of appetite. This was followed soon by rapidly developing jaundice of a very intense type. Pressure in the right hypochondrium elicited a good deal of tenderness, and this was also quite pronounced when he yawned. He visited a dis pensary, where his case was diagnosed as one of typhoid fever. His jaundice persisted for about two months, as did also the pain, and a physician who saw him at that time pronounced the case one of appendicitis. He was then taken to Dr. Max Einhorn, who discovered a tumefaction in the region of the liver, and suspected that the case was one of abscess of the gall-bladder or chole lithiasis. The patient was referred to the Babies' Wards of the Post-Graduate Hospital, where Dr. Dunham saw him together with Dr. Chapin. A tumor situated about the region of the gall bladder was plainly perceptible to the touch and slightly so to the eye. While the child was under observation his temperature fluctuated greatly, ranging from 99° to 105° F.; his pulse from Lao to 165; his respirations were not particularly increased. An examination of the blood showed a leucocytosis of 21,800, and the blood contained a number of leucocytes which gave the iodine reaction. The speaker said this convinced him that pus was pres ent, but its exact location was uncertain.
An incision was made over the site of the tumor, and after breaking up some frail adhesions the gall-bladder was found to be apparently normal. The exposed portion of the liver was then stitched to the outer tissues and the wound packed with gauze until the following day, when, under ether, an aspirating-needle was inserted into the liver, and at a depth of three-quarters of an inch it entered a pus cavity. The opening was thereupon en larged and disclosed an abscess cavity about an inch by half an inch in size. After evacuating it, it was irrigated with peroxide of hydrogen through a large drainage tube, which was left in for fifteen days. The patient made an excellent recovery, and his subsequent history was uneventful.
The pus from the abscess cavity was examined by Dr. E. K. Dunham, and was found to contain a pure culture of staphylo coccus pyogenes aureus.