At this stage we have a leucocytosis in which the polymorphonuclears are but little increased in percentage with a low remittent fever. At this time Rogers considers that the disease may be cured by emetine or ipecac and liver abscess avoided. =A Typical Case of Liver Abscess.=—Following a case of amoebic dysentery, during the period of convalescence or subsequently, a rather irregular type of fever is noted, which shows an evening rise with sweatings which tend to become colliquative. From a marked feeling of weight in the region of the liver there may later develop tenderness or pain upon palpation of the liver. Of importance is the fact that there is no associated splenic enlargement. In the majority of cases the right side of the liver enlarges in an upward direction. A tape-measure will often show enlargement of the right side. Pain referred to the right shoulder is often complained of when the abscess is located in the upper convex part of the liver but, when nearer the inferior concave surface, there may be pain referred to the region of the appendix. When located in the left lobe the symptoms may be considered as of gastric origin. The upward enlargement of the liver as shown by X-rays is of great value in diagnosis, but an abscess located in the center of the liver is not indicated by such rays. There is a marked tendency to splint the liver so that the patient tends to lie towards the right side and when walking applies his right arm and forearm to his side, which led Koch to remark, “It is as if he carried his abscess under his arm.” The right rectus often shows rigidity. Auscultation of the base of the right lung reveals a moist crepitation which, together with a dry cough (tussis hepatica), the fever, evening sweats, anaemia and emaciation, may suggest tuberculosis. The respirations are shallow as deep inspiration tends to cause pain. It must be remembered that cases of liver abscess have been reported where there were practically no symptoms. Insomnia is a marked feature in many cases. Jaundice is rare, but an earthy color or subicteroid tinging is often noted. The superficial veins may be enlarged. The urine is scanty and high-coloured, frequently with a marked increase in the ammonia nitrogen. Urobilin may be present in considerable amount. There is a rather constant but low leucocytosis of from 12 to 20 thousand, which shows only about 70% of polymorphonuclears with an increase in large mononuclears up to 10 to 15%. The final proof is the obtaining of the chocolate-coloured or anchovy sauce-like pus by exploratory puncture. [Illustration: FIG. 61.—Temperature chart of liver abscess.]