normal and he felt much better. However, on the following day the temperature again rose, this time to 103 F. Ever since this time it had showed an intermittently septic course. Four days prior to admission he became progressively jaun¬ diced, coughed and expectorated thick mucopurulent sputum, which was without a foul odor. This condition lasted only two or three days, at which time the cough and expectoration ceased. Careful examination of the sputum disclosed no pneumococci, but many gram-negative rods were in evidence on all occasions. This condition lasted for one week, when there occurred fre¬ quent chills, high fever and jaundice. The chills were so severe that some lasted as long as one hour with a rise in temperature up to 105 or 106 F. Strangely enough, at the termination of an attack of chills and fever the patient no longer appeared acutely ill.On admission and immediately thereafter the temperature reached a height of 105.4 F. and receded to 99.8 F. The pulse rate was 120 per minute and the respiratory rate 40 per minute. On physical examination the patient seemed well nour¬ ished and not acutely ill. The skin and conjunctivas indicated an intense degree of jaundice. The lung fields were normal on physical examination as well as on x-ray study. The abdomen was greatly distended but revealed no areas of tender¬ ness and no masses. Exploratory aspiration in the subdiaphragmatic and hepatic spaces posteriorly gave negative results. Urinalysis always revealed bile. March 19 the blood showed 3.590,000 erythrocytes, 14,350 leukocytes, 73 per cent hemo¬ globin, 80 per cent polymorphonuclears, 4 per cent monocytes, 14 per cent lymphocytes and 2 per cent myelocytes. By March 22 the leukocytes increased to 21,350, the hemoglobin dropped to 67 per cent and the polymorphonucl ear leukocytes increased to 88.5 per cent. Smears for malarial parasites were negative, and repeated blood cultures were also negative.Operation.-With use of subdural block anesthesia the peri¬ toneal cavity was opened through a right rectus incision and a moderate amount of thin odorless yellow fluid was encoun¬ tered. More than a pint was removed by suction. The entire liver surface, especially the right lobe, contained innumerable light yellow softened areas ranging from a few millimeters to 2 and 3 cm. in diameter. The larger involved areas were raised above the surface and soft to palpation. The picture was one of multiple liver abscesses. Aspiration of a large abscess with needle and syringe revealed liquefied necrotic material, culture of a specimen of which was taken. The gall¬ bladder was incised and a large rubber tube was inserted for drainage. Along the portal system and bile ducts many enlarged lymph glands were palpated. No calculi were felt.No difficulty was experienced in recovering Friedländer's bacillus from all three specimens, namely liver abscesses, gall¬ bladder content and free abdominal fluid. Intensive treatment with sulfanilamide was given ; blood samples showed 10.7 mg. per hundred cubic centimeters in the blood s...
