before and fever once more subsides. This process of alternate emptying and refilling of the abscess cavity may recur many times before recovery finally takes place. In some cases it continues for months, and may finally wear out the patient. Abscess may form in the lung ; or a sudden and fatal hæmoptysis may be brought about by ulceration opening some large pulmonary vessel. In some, expectoration never altogether ceases; if accompanied by fever this persistency indicates imperfect drainage, or, possibly, the presence of a second and unruptured abscess.
Characters of the expectorated liver pus.— The appearance of expectorated liver pus is almost pathognomonic. In colour it is chocolate brown; in consistence it is viscid and jelly-like. It may be streaked with blood; sometimes the expectoration may be almost entirely pure blood. Not infrequently these hæmorrhagic cases are regarded and treated as examples of ordinary hæmoptysis. Presumably, in the majority of instances, this blood comes from the wall of an abscess jarred and torn by the succussion of the harassing cough. Under the microscope expectorated liver pus exhibits the appearance already described (p. 582).
Rupture into the pleura leads to sudden development of evidences of pleural effusion which, unless relieved by drainage, may, in its turn, give rise to all the signs of empyema, and terminate in death, or in rupture through the lung or chest wall.
Rupture into the stomach is generally signalized by vomiting of the characteristic pus and, at all events temporarily, by cessation of local symptoms and fever.
Rupture into the bowel may cause diarrhœa, the pus, more or less altered, appearing in the stool. This is an occurrence that is frequently overlooked.
Rupture into the pericardium, or into a blood-vessel, is almost necessarily and rapidly fatal.
Rupture into the peritoneum is, of course, a serious occurrence, but, I believe, not necessarily fatal. The majority of liver abscesses, as will be presently described, do not contain the ordinary septic bacteria,
