Pyogenic liver abscess.

At the turn of the century, the mortality from liver abscess was 100%. Surgical drainage reduced the mortality to 50 to 75% by 1930. Antibiotics led to a further reduction but there was little change in the mortality during the next 25 years until recently when the adoption of special localization techniques promised a great improvement. In the nineteenth century a common cause of liver abscess was undiagnosed appendicitis. This has been corrected, so eliminating deaths in the young age groups. The condition now affects predominantly the aged and enfeebled but it remains a condition with a high mortality and morbidity despite diagnostic aware- ness and therapeutic improvements. Liver abscess is sometimes only one manifestation of severe infection elsewhere. The initial features of the disease may be non-specific and the fully developed picture is late in appearing. Consequently there may be delay or failure in diagnosis. Inadequate drainage of multi- loculated abscesses or failure to drain secondary abscesses adds to the problem. Few see many cases and this stresses the need for a continual review of the condition in all its aspects. MATERIAL During the 10-year period 1957-66, 48 patients with liver abscess were admitted to two Bristol hospitals, and have been classified as follows: