Where the abscess is situated far back or high up in the liver the transpleural route is to be preferred to the abdominal one. Make a 3 or 4 inch incision over the 9th rib with its center in the line of the angle of the scapula. Excise about 2 inches of rib subperiosteally. An assistant presses a roll of gauze against the tissues above the line of incision to prevent air entering the pleural cavity. Later the upper flap may be sutured to the endothoracic fascia. Even if the pleural cavity should be opened and air enter no serious result will follow although it is an accident to be avoided if possible. The diaphragm is now cut through and the liver exposed and after packing gauze around the area to be opened, the abscess cavity is entered and drained as previously described. McDill prefers to resect 2 or 3 inches of both 9th and 10th ribs in the midaxillary line. The muscle wounds made in resection are then closed by catgut. This movable wall is now forced against the diaphragm with a roll of gauze pressed inward by an assistant. A 3-inch incision is now made through this bone-free wall near the upper border of the 11th rib, going through diaphragm and exposing the liver. The edges of the wound in the thoracic wall and diaphragm are now clamped together by haemostats to close off the pleural cavity. Later catgut sutures are substituted for the forceps. The liver often bulges into the wound. Finding the abscess by a palpating finger as a rather firm area in a less resistant liver surface we introduce a forceps or aspirating needle or trocar and proceed as above noted. There are indications that the use of emetine subcutaneously may make the more radical operations unnecessary. In a recent symposium on liver abscess many of the papers would indicate a preference for aspiration without drainage coupled with emetine subcutaneously. Rogers, in a recent article, notes that a case of liver abscess was cured by emetine without any form of operation. Recent experience, however, would indicate that it is necessary to evacuate the pus to effect a cure. SECTION II DISEASES DUE TO BACTERIA CHAPTER XII BACILLARY DYSENTERY HISTORY AND GEOGRAPHICAL DISTRIBUTION =History.=—Epidemics of dysentery have been noted since ancient times, the widespread and fulminating nature of such outbreaks in times of war and famine having impressed observers in all ages. The disease is mentioned in the Ebers Papyrus (1600 B. C.). Herodotus referred to an epidemic of dysenteric nature in the Persian Army and Hippocrates described the dysenteric syndrome. It has been known in India since remote times.