A Case of Hepatic Abscess (?) Treated by a Vaccine; Recovery.

Abstract

LATE HONORARY PHYSICIAN TO THE WESTMINSTER G ENERAL DISPENSARY. THE patient was a single man, aged 37 years. A .grandfather, an uncle, two aunts, and a brother and sister had died from tuberculosis. In the beginning of May, 1906, while living in Bombay, he had an attack of dysentery. On May 26th, 1906, he sailed for England, arriving in London on June 10th. Two days after leaving India he developed appendicitis. On June 12th Sir Patrick Manson was consulted, and by him the patient was sent into a nursing home on the following day. On the 20th the patient was operated on, a large abscess and a gangrenous appendix being found. On the 26th the wound had to be opened up again and a further operation performed. It was at one time feared that a third operation would be necessary, but happily this was avoided. The abdominal wound healed by granulation, and a tendency to ventral hernia from a weak scar resulted. The patient left the nursing home on July 30th and continued to gain strength and enjoy fairly good health until the following November, when he was again down with an illness which was named "acute gastritis." This attack lasted a month and so reduced his strength that he was advised to go away early in January, 1907, to Adelboden in the Bernese Oberland. While in Switzerland the patient had another '' slight .attack of gastritis," in which he was told that his liver, right lung, and kidney 7vere affected. I would direct special attention to these illnesses after the appendicitis operations, and particularly to the statement that his liver, . right lung, and kidney were affected in the second attack of " gastritis," as I believe them to be of importance in the interpretation of the sequel. The patient returned to London in February, 1907, but being unfit to resume his duties in .Bombay applied for an extensio of leave and was granted a month. On March 15th he sain d for India and arrived on the 29th of the same month tolefind the hot season one of unusual severity. On April 29th he had a "touch of fever" " and kept his bed for a week, after which he got up and went about as usual till May 15th, when he took to his bed again with low fever." From this date till June 26th he had constant fever, rigors, and vomiting, when an abscess burst into his lung and he coughed up an immense quantity of pus, blood, and anchovy-paste-like expectoration. The patient remained in India till July 20th, during which time he continued to cough up a large amount daily of similar matter. On that day he embarked for England, arriving in London on August llth. His sufferings on board were frightful and I have no doubt from his description of himself at nights that he must have had a high temperature and been delirious. To add to his miseries he developed an attack of colitis while at sea and was tortured by tenesmus, acute abdominal pains, and incessant calls to evacuate the bowels. For the first two days after his arrival in London the patient refused to see a medical man, as he was afraid his case would be diagnosed and treated a...