550 
may exist without discoverable lesions in the bowel at the time of the 
death of the patient. 
Since my previous discussion which touched this subject,* one case of 
liver abscess has been encountered, in which the most careful and per- 
sistent search failed to give evidence of a previous dysentery, and there 
was no history of antecedent dysentery or diarrhcea. However, similar 
conditions and findings have occurred in other cases in which, some 
months before, there was a perfectly clear history of dysentery. There- 
fore, by taking everything into consideration, the conclusion is justifiable 
that the majority, if not all, of the cases of ameebic abscess of the liver in 
which, at autopsy, intestinal lesions were not discernible, occurred in 
individuals who had previously suffered with ameebic colitis, which had 
finally healed, and in which the amcebe reached the liver during the 
period of active ulceration of the colon. 
Relation of liver abscesses to the location of intestinal ulcers.—There 
does not appear to be any definite relation between the occurrence of 
liver abscess and the location of the intestinal lesion, or between it and 
the location of an intestinal perforation, should one occur, although 
the observations of several recent writers and my own indicate liver 
abscesses to be most frequent where there is ulceration of the caecum and 
ascending colon. 
In one series of 27 abscesses, 15 occurred without the perforation of the ulcers 
in the intestine; there were ulcerations in the cecum and ascending colon in 
8; in 1 in the transverse, and in 3 in the descending colon, 
Again, in another series, we have perforations in the cecum or ascending colon 
9 times with 6 cases of liver abscess, and perforations in the descending colon 
8 times with 1 liver abscess. In one series of 13 perforations of the intestinal 
ulcers, without liver abscess, 10 were below the hepatic flexure of the colon. In 
11 solitary abscesses of the right lobe, the colon was ulcerated throughout in 6, 
and the cecum and ascending colon alone in 5. In 2 multiple abscesses of the 
right lobe, the intestinal ulceration was general; in 8 multiple ones of right and 
left lobes, the entire bowel was ulcerated, and in 1 solitary abscess of the left 
lung, the transverse colon alone was found, at autopsy, to be ulcerated. 
The location and the number of abscesses.—In over 90 per cent of all 
amoebic abscesses the right lobe is involved, either alone or in connection 
with other portions of the organ. It is the only one affected in over 70 
per cent; and in 40 to 65 per cent of all cases the abscess is a solitary 
one. The most common condition by far, is a solitary abscess situated in 
the dome of the right lobe, and in this connection it must be remembered 
that solitary abscesses are not infrequent in the left lobe, less common 
in the lobus spigeliit and that they occur only occasionally in the quadrate 
lobe. In rare instances, also, multiple abscesses have been confined to 
the left lobe, and once I have seen three small ameebic ones in the lobus 
8 Publications Biological Laboratory, Bureau of Government Laboratories, Ma- 
nila (1904), 18, 112. 
