As the case progresses emaciation increases; hectic with drenching nocturnal sweats continues; the liver dullness and pain may further increase; or the general enlargement may somewhat subside, and percussion may reveal a pronounced local bulging, upwards or downwards. If the abscess which has now formed is not relieved by operation, after months of illness the patient may die worn out; or the abscess, which has attained enormous dimensions, may burst into the right lung or pleura, or elsewhere, and be discharged, and either recovery, or death from continued hectic and exhaustion or from some intercurrent complication, ensue.
Great variety in the urgency of symptoms.— Although the foregoing is a fairly common history in liver abscess, there are many instances in which the initial symptoms are much more urgent, and in which the disease progresses much more rapidly. In other instances subjective symptoms are almost entirely absent; or so subdued that the true nature of the case may be entirely misapprehended until the abscess bursts through the lung or bowel, or a fluctuating tumour appears in the neighbourhood of the liver; or, perhaps, not until after death, when the unsuspected abscess is discovered on the post-mortem table.
Fever.— In an acute sthenic case the initial inflammatory fever may run fairly high and persist for some time. Later, when it may be assumed that pus has formed, the fever becomes distinctly quotidian and intermittent in type, the morning temperatures being normal, or only slightly above normal, the evening rising to 101° or 102° F., or a little over or under this. Sometimes evening temperatures of 103°, rarely of 104°, are registered. In the asthenic and insidious type, at first there may be short flashes of feverishness at more considerable intervals, to be followed later by a steadier fever of a hectic type, as in the suppurative stage of the sthenic cases. In either type there may be afebrile intervals of several days' duration; and in either there may also occur, concurrently with aggravations of the local conditions, spells of continued high temperature. Occasionally,
