and falling of the organ in respiration. If the needle does not exhibit this movement, its point may be in an abscess cavity, but this abscess is not in the liver.
Treatment.— Hepatitis which has not proceeded to abscess formation should be treated, especially if dysentery be present or have been antecedent, with full doses of emetine or of ipecacuanha, repeated once or twice a day for two or three days or longer, by a cautious use of the purgative sulphates, and with poultices, rest, and low diet. Rogers has recently reiterated the value of emetine and ipecacuanha in such circumstances. If there be much pain, relief may be afforded by either wet or dry cupping over the liver, or by leeches around the anus. Ammonium chloride, in 20-gr. doses three times a day, is usually prescribed.
When the occurrence of rigor, or the development of hectic, or the appearance of local bulging, or the persistency of the fever and of the local symptoms, gives ground for suspecting that abscess has formed, active medication must be suspended, a somewhat improved dietary prescribed, and measures taken without unnecessary delay to locate by means of the aspirator the position of the pus.
When he proceeds to use the aspirator, the surgeon must be prepared to open and drain the abscess if pus be discovered once diagnosis is established, nothing is gained by delay. By proceeding to open the abscess at once, the shock of a double operation is avoided, and only one administration of the anæsthetic is required.
To facilitate aspiration, as well as the subsequent operation if such should be found to be necessary, the patient ought invariably to be placed under an anæsthetic. Unless in very special and exceptional circumstances, it is a mistake to attempt exploration without this, for the surgeon ought to proceed with deliberation and to feel himself at liberty to make as many punctures as he may think necessary. A medium- or full-sized aspirator needle should be used, as owing to the nature of the pus it may not flow through a cannula of small bore.
