BY B. F. JOSLIN, JR., M.D., NEW YORK.

The following report is of interest as relating to a form of disease of not very frequent occurrence, nor of very easy diagnosis, as well as on account of the entire recovery of the patient. Only one similar case of Abscess in the Liver, opening through the Lungs, has come to my knowledge in homoeopathic practice. This occurred in the son of a distinguished clergyman of this city, and was successfully treated by Drs. Bayard and Joslin, Sen.

Budd says, (p. 109) of Abscess of the Liver: “The physicians who have had most experience in this disease, confess their inability in many cases, to distinguish it from other diseases of the Liver; and in some, even to pronounce that the Liver is the seat of disease at all.” My own quite limited experience in this affection, fully accords with the above.

The case which I purpose reporting at the present time, was considered by the physician who was in attendance previous to myself to be one of far advanced consumption; he prognosticated that the patient would live but a few days. Judging from her general appearance, I did not think she was the subject of Phthisis Pulmonalis, although I suspected the heart might be the seat of disease. It was some two months after I first saw her, before the nature of her disease was fully comprehended. One principal reason of this was that a complete physical examination of her chest was delayed. The weather was cold and her apartment insufficiently warmed, so that I feared she might suffer from the exposure consequent upon such examination. When I did make a thorough physical investigation, I found evidences of enlargement of the Liver, there being complete dullness of the chest below the level of the nipples, and on measurement around the lower part of the chest, the right side was found to be more than four inches larger than the left. These facts led me to examine more minutely than I had done the matter expectorated — when pus, bile, and fat globules in it, were made apparent by the microscope, and the fat extracted by means of sulphuric ether.

The general history of the case was as follows: She is a young woman, the wife of a sea-faring man. About five years before I saw her, (Jan. '57,) she contracted Chagres Fever, was treated with mercury to salivation, and with large doses of quinine, both on the Isthmus and in New York; recovered, and enjoyed pretty good health until the birth of her second child in October, 1855. Six weeks after this time she had severe pain in the left shoulder and arm, so that the latter was rendered helpless for a time; had pains in chest, and a short time after, expectoration of a quantity of darkcolored blood. Then cough, with expectoration of dark and bright blood, with brownish and yellowish matter, which continued almost constantly. The expectoration was always of an offensive bitter and sour taste to herself, and somewhat offensive smell to others. The amount of blood expectorated was quite considerable, amounting at times to as much as a quart in twelve hours. The evacuations from the bowels were normal in appearance but costive.

At the time I first saw her, she had been confined to her bed for some months. She had lost much flesh.

The following are my records made at the time of seeing the patient:

Jan. 13th, 1857. — Cough for a year; has raised blood and pus. Prescribed I Phosphorus³⁰., and Sach. Lact.

20th. Pulse 92. Cough about the same; at times raises blood, and afterward matter having an offensive taste and smell; has burning in the chest; appetite pretty good. Arsenic³⁰, was given.

28th. Pulse 96. Has had considerable cough and expectoration of pus and blood, less offensive than formerly; Fever for three afternoons past; Regurgitation of food after eating and coughing. Bryonia³⁰.

Feb. 11th. Pulse 96. Raised considerable blood last week. Dryness in throat excites cough; Expectoration offensive; Coughs more in evening. Arsenic ³⁰., solution, morning and evening.

15th. Pulse 94. Rather less cough. Sach. Lact.

21st. Has been better this week. Examined her chest slightly, both sides rather dull; Heart's action heard over the right chest; Respiration somewhat prolonged under the right clavicle, slight rattle. Sach. Lact.

25th. Pulse 100. Expectoration of black matter; Cough about the same. 1 Arsenic³⁰

March 4th. Pulse 90. Considerable expectoration of blood for a day or two, more than for three weeks past; Pains in the stomach, worse on coughing; Appetite not quite so good as usual. The blood expectorated is partly bright and clear, a portion dark colored, together with very viscid matter of a dark brown color; Expectoration offensive to herself and others. China³⁰, every 4 hours.

8th Pulse 100. Expectoration of blood continued until last night; considerable pain in the left side and stomach; Coughs when lying on the left side. Arsenic³⁰., 3 times a day.

11th. Feels better. Is raising blood. Continued Arsenic³⁰.

25th. Severe pain in the hypochondrium, and sallowness for several days past. The pain comes on in the afternoon. Bryonia⁷, solution, every 3 hours.

27th. Pulse 72, (a remarkable and quite sudden reduction in frequency it will be observed). Skin moist. She is much better now, than at any previous time this winter. Was relieved promptly by the Bryonia⁷.

Made a more particular physical examination of her chest. Results as follows:

Slight apparent dullness just under claviculae; below this both sides alike, but not as clear as is usual, until I in percussing downwards I arrived at the line of the nipples, when both sides became decidedly dull; at this point on the right side has frequently had a burning pain. The heart's action is heard over both sides of the chest. Can not hear vesicular respiration distinctly anywhere. Continued Bryonia³⁰, solution, every 3 hours.

At this visit I procured a specimen of the matter expectorated, which I took home and examined. It consisted of blood, and of a yellowish brown substance, which I had supposed to be nothing but pus, but a microscopical examination showed pus, bile and fat globules. On adding sulphuric ether to some of this yellowish brown matter, and allowing the ether to evaporate, a greasy matter was found to remain.

This was the first time that I had carefully examined the chest. The occurrence of dullness of all parts of the chest below the horizontal plane of the nipples, and the great preponderance of the size of the right over the left side, below these points, led me to suspect the true nature of the disease, and the microscopical and chemical investigations fully corroborated the diagnosis.

April 6th. Has been much better of late. Coughs less. Pulse 80. Night sweats for a few nights past. Bowels costive. Bryonia³⁰.

11th. Found her up, had been sitting up some time; her pulse was 104. Bryonia³⁰.

16th. Was moved since my visit about a mile distant from her former residence; did not appear to be injured by it. Has been inclined to sleep of late. Sent from office Rhus. rad³⁰.

20th. Visited her. Has been quite smart since she was moved. Pulse 72. Cough, expectoration, and pain in the shoulder — all slight; complains of weakness and aching in the small of her back. Had dysentery a month after she commenced raising matter, had none previously. Nux³⁰., solution, 3 times a day.

29th. Not quite so well for two days. Pain in the left upper chest and in the shoulder. Bryonia³⁰.

May 9th. Pulse 76. Rather more expectoration this week; last night raised a small quantity of dark coagulated blood, and brownish matter; very little cough; Bowels regular; Complexion clearer; Appetite good; Sleeps well; very little pain. Bryonia³⁰

21st. Has been quite well until yesterday. Was attacked last night with severe pain in epigastrium, like colic, but is better to day. Nux⁶.

22d. Pulse 68. No pain since. Nux³⁰., morning and evening.

June 1st. Doing well. Nux³⁰.

July 25th. Since day before yesterday has had expectoration of blood. Has been working quite hard of late. Bryonia³⁰.

Aug. 11. Has gained flesh, and has been quite well until within a few days. Has now cough; raised a small quantity of blood several days ago. Bryonia ³⁰.

18th. Has raised several mouthfuls of blood since. Bry³⁰. Sept. 1st. For 4 days past has expectorated blood and matter, such as she raised last winter. Sent her Bry⁷., 3 times a day.

5th. Visited her. Has expectorated no blood since, but has raised offensive brown matter. Bry³⁰., a dose at night.

14th. Raised 4 or 5 mouthfuls of blood and matter this morning. Pulse 84. Bryonia⁷., morning and evening.

Oct. 9th. Has been pretty well. Has raised pieces of a dark brown color, not offensive, but no blood. Bryonia³⁰.

Has not had any indication of hepatic or pulmonary disease since the last date. In November of the same year, (1857) had a miscarriage at 2 months, but made a good recovery. On the 30th of November of the following year, was delivered of a fine boy. She had no sickness of any kind following, requiring medical attention only for forms sake.

She has enjoyed most excellent health since her recovery, and is now vigorous.

The improvement in her case was gradual from the first attendance Jan. 13th, 1857, to the 27th of March, when a rather sudden reduction in frequency of pulse occurred; continued to improve, and was able to sit up on the 11th of April, and between that and the 16th, was moved a distance of a mile or more, without any apparent injury. Was not confined to her bed after this, excepting for the miscarriage, and at the period of her confinement; but after her moving took charge of the ordinary household duties, devolving upon those not rich enough to keep servants.

---