tery is almost forgotten. Or there may be no active hepatic symptoms with the dysentery, hepatitis supervening only when all bowel trouble has long passed away. In a few cases no dysenteric history can be elicited; it is seldom, however, as has already been insisted on, that careful inquiry fails to bring out some story of previous bowel disturbance more or less urgent. In a few instances liver abscess of tropical origin does not declare itself until the patient has been several years resident in a temperate climate and quite outside the endemic area.
The incidence of the symptoms is equally variable. Some cases commence with marked sthenic fever, much local pain, great tenderness and hepatic enlargement, the signs of suppuration, as rigor, hectic, and local bulging, rapidly supervening. Others, again, commence so insidiously that the patient can hardly say when he first began to feel ill; perhaps there may be a history of slow deterioration of the general health during a year or longer before definite hepatic symptoms show themselves. The former type seems to be the more common in the young and robust new-comer to the tropics; the latter, in the more or less cachectic and old resident. Between these extremes there is endless variety.
Duration of the disease.— Liver abscess may run its course in three weeks. Generally it is an affair of several months. Sometimes it may run on for a year or even longer; particularly so if it burst through the lung and drainage be imperfect, in which event the cavity may keep on bursting and refilling at intervals for almost an indefinite period. Occasionally a liver abscess becomes encysted and gives rise to no further symptoms, its existence being discovered only on the post-mortem table, the patient having died of quite another and independent disease.
Terminations.— Apart from operative inter- ference, liver abscess may terminate in various ways. It may end in spontaneous rupture leading to death or recovery. Death may also be brought about in other ways— by the severity of the local disease; by prolonged hectic and exhaustion; by concurrent
