outside. If temperature keeps normal, if pus gradually or intermittently decreases, and if the body-weight is maintained or increases, operation is unnecessary, or, at all events, should be deferred.
In exploring the liver in such cases it must be borne in mind that most likely the abscess cavity is collapsed, and that the sides of the abscess may be in contact. Such an abscess is not likely to be discovered unless the needle be thrust in to its full extent, and, whilst a good vacuum is being maintained in the aspirator, slowly withdrawn. If by good fortune the abscess has been traversed, then, when the end of the needle is crossing the cavity, a small amount of pus will be seen to flow. Great care must now be exercised to keep the needle in position so as to serve as a guide in opening the abscess. Recovery has been known to follow the introduction of a drainage-tube in the presumed direction of such an abscess, even although the abscess cavity was not entered, much less drained, by the tube.
Treatment of abscess rupturing into a serous cavity.—When there is evidence that an abscess of the liver has ruptured into the peritoneum, into the pleura, or into the pericardium, the particular serous cavity involved must be opened at once and treated on general surgical principles ; otherwise the patient will almost surely die. In the circumstances the surgeon will be justified in assuming great risks.
The prognosis in early operations on single abscess of the liver, provided there is no dysentery or other complication, is good. In multiple abscess, or in single abscess if there is active dysentery or other serious complication, prognosis is bad. In multiple abscess, if there are more than two or three abscesses, it is necessarily hopeless.
The question of return to the tropics after recovery from liver abscess frequently crops up. If feasible, and if the patient has not to make too great a sacrifice, he ought to remain in a temperate and healthy climate. There are many instances, however, of individuals who have enjoyed permanent good health in the tropics after recovery from liver abscess.
