renee. ee a, ly ee eee ne 
549 
Frequency and association with intestinal amcebiasis.—Rogers collected 200 
cases of amebic liver abscess in examining 5,000 miscellaneous autopsy records 
in India. Among 10,603 patients (from American troops) in the Philippine 
Division Hospital it was diagnosed 34 times (Coffin). Strong and Musgrave 
encountered liver abscess 27 times in 400 miscellaneous autopsies performed, for 
the greater part, on American soldiers in the Philippines. In the first thousand 
patients, from a cosmopolitan population, admitted to St. Paul’s Hospital, Manila, 
liver abscess was found in 12, 
In the great majority of patients the abscess complicates an amoebic infection 
of the colon and its frequency in this disease is variously estimated as being from 
5 to over 75 per cent of the cases. Councilman and Lafleur collected 486 liver 
abscess cases from the records of 2,430 autopsies on dysentery. Rogers found it 
in about 20 per cent of his large series; Strong and Musgrave in 23 of 100 fatal 
cases, mostly among American soldiers; Harris in 15 of 95; Futcher, in 27 of 
the 119 in the Johns Hopkins Hospital series; Craig in over 50 per cent of 
3,210 collected cases and in 33.7 per cent of his own series; Coffin in 34 of 859 
among American soldiers. 
In the first 100 cases of amebiasis treated in St. Paul’s Hospital, of which 9 
came to autopsy, it has been found 12 times. The diagnosis in each instance 
was made during life. It occurred 10 times in Americans and Europeans and 
twice in natives of the Philippine Islands. 
In the great majority of cases the evidence that the abscess is sec- 
ondary to ameebic infection of the colon is conclusive, but there are a 
number of instances in which it might appear to represent a primary 
amcebic infection of the liver, since the most careful search at autopsy 
fails to show any evidence whatever of a lesion of the bowel. Ameebic 
liver abscess is considered to be a distinct disease. That amcebe could 
reach the liver in any other way than from the bowel seems improbable, 
and, if we admit this, there are then but three possible explanations of 
the apparently primary infection of the liver: 
First. Amoebee may reach the liver by the gall ducts. 
Second. They may penetrate the bowel wall without producing ap- 
parent lesions; or 
Third. The bowel lesions may have been entirely repaired. 
The first of these propositions is untenable, because amcebe have not 
been found in the gall bladder and ducts or even in the upper part of the 
intestine and, moreover, the undiluted bile is, at least in cultures, toxic 
for ameebe. The second is a possible one, especially when we consider 
Schaudin’s observations and the pathology of the early lesions of colon 
infection, as pointed out by several observers, and recently by Woolley and 
Musgrave.* However, the third furnishes the most satisfactory explana- 
tion, for it is well known that the process of repair, even in very extensive 
lesions of the intestine, is often so complete that no macroscopic evidence 
of the disease remains. In whatever manner the mode of entrance may 
be explained, the fact is fully established that amoebic abscess of the liver 
* Publications Biological Laboratory, Bureau of Government Laboratories, Manila 
(1905), 32, 31. Also Jr. A. M. A. (1905), 45, Sept. 16 and Nov. 4. 
