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XXXIV] though rarely, liver abscess may be unattended by fever of any description whatever. Rigors.— In the classical descriptions of liver abscess the occurrence of violent rigor is generally mentioned as a notable sign of the formation of pus. Undoubtedly such a rigor does at times signalize this event; but it is by no means constant, and its absence is no guarantee that abscess has not formed. Generally the evening rise of temperature is preceded by a sense of chilliness, sometimes by a more marked rigor simulating, in the regularity of its recurrences and in its severity, the rigor of a quotidian malarial fever.

Sweating, particularly nocturnal sweating of a very profuse character, is an almost invariable accompaniment of liver abscess. The patient's clothes may be literally drenched with perspiration. Even during the day— particularly, as already mentioned, if he chance to fall asleep— the sweat may stand in beads upon the forehead and around the neck. This, like most of the other symptoms, may be temporarily absent or, in a small proportion of cases, trifling. The complexion is generally muddy, cachectic, and slightly icteric-looking; marked jaundice, however, is uncommon.

Wasting is generally decided and progressive.

Rheumatic-like pains and swelling of the hands and feet, such as occur in chronic septic affections, are sometimes to be noted. They usually disappear-rapidly when the abscess bursts or is opened and free drainage is established.

Pain of some description is rarely absent. In a few exceptional cases there is no pain; such a patient may declare that he does not know that he has a liver.

There are several types of pain— local and sympathetic— associated with liver abscess. Complaint is almost invariably made of a sense of fullness and of a sense of weight in the region of the liver, not infrequently referred to the infrascapular region. Stabbing, stitch-like pain, increased by pressure and