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XXXIV] hepatitis of a non-suppurative nature, such as that attending malarial attacks; suppurative hepatitis before the formation of abscess; syphilitic disease of the liver— softening gummata which are often attended with fever of a hectic type; pylephlebitis; suppurating hydatid; gall-stone and inflammation of the gall-bladder; subphrenic abscess; abscess of the abdominal or thoracic wall; pleurisy; encysted empyema; pyelitis of the right kidney; pernicious anæmia; leucocythsernia; scurvy and similar blood diseases associated with hepatic enlargement; ulcerative endocarditis; kala-azar; undulant fever; trypanosomiasis. Any of these may be attended with fever of a hectic type, increased area of hepatic percussion dullness, and pain in or about the liver.

Many times a correct diagnosis can be arrived at only by repeated and careful study of the case in all its aspects. Golden rules in tropical practice are to think of hepatic abscess in all cases of progressive deterioration of health; and to suspect liver abscess in all obscure abdominal cases associated with evening rise of temperature, and this particularly if there be enlargement of or pain in the liver, leucocytosis, and a history of dysentery not necessarily recent dysentery. If doubt exist, there should be no hesitation in having early recourse to the aspirator to clear up diagnosis, after employing emetine or ipecacuanha as a therapeutic test.

As bearing on prognosis, apart from the risk from sudden rupture in some untoward direction, to overlook abscess of the liver is a much graver error than to mistake some other disease for liver abscess; for the chances of recovery from operation are proportionately prejudiced by every day's delay. Low pneumonia of the right base in a tropical patient should always be regarded with suspicion; in most instances it means abscess of the subjacent liver.

Perhaps the most common error is to regard the hectic of liver abscess as attributable to malaria. The regularity with which the daily fever recurs, the daily chilliness or even rigor coming on about the same hour, the profuse sweating, and other circum-