the chest seeming to be fixed especially the right side— and the diaphragm almost motionless.
The decubitus is usually dorsal or right dorsal, the body being somewhat bent towards the right side and the right leg perhaps slightly drawn up. When the patient stands, a stoop to the right may be noticeable. Lying on the left side generally causes pain from dragging on adhesions, or discomfort from the pressure of the enlarged liver on the heart and stomach. Occasionally the decubitus is indifferent, or even on the left side.
The digestive organs are usually disturbed and the tongue is coated. Vomiting may occur from time to time, arising either from pressure on the stomach by the swollen liver or as an expression of gastric catarrh ; appetite, as a rule, is poor; flatulence may be troublesome; the bowels are confined or irregular, or there may be diarrhœa or dysentery. In the case of concurrent dysentery, it may be noted sometimes that the hepatic and dysenteric symptoms alternate in severity.
The area of hepatic percussion dullness is usually extended upwards and downwards, and sometimes horizontally. The extension may be general, especially in the earlier stages; later, careful outlining of the upper and lower boundaries may discover a limited and dome-like increase in one direction, most significant if upwards. The upper line of dullness is not, as a rule, horizontal, as in hydrothorax; almost invariably, on approaching the spine, it trends downwards more markedly than in hydrothorax or empyema. Variations in the extent of the dullness may take place from time to time, and sometimes very rapidly, depending not on fluctuations in the size of the liver abscess, but on the varying and relative amounts of local and general hepatic congestion. One sometimes finds even a narrow hepatic dullness in the nipple line, with a great increase in the axillary or scapular lines. In one case the lower border of the liver may be as low as the umbilicus; in another, especially in front, it may be well inside the costal margin. Diagnosis in the latter type of case is difficult, and depends
