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spigelu alone. Although small abscesses are frequent and larger, soli- 
tary ones are occasionally seen in the deep substance of the liver, in the 
great majority of cases they are rather close to the surface, whichever 
lobe is involved. Sometimes, shallow abscesses several centimeters in 
diameter are situated between the dome of the liver and the diaphragm, 
but not extending more than 1 or 2 centimeters into the liver substance, 
the superior surface of such abscesses being entirely formed of a portion 
of the diaphragm. ‘'T'wice I have seen very shallow, subcapsular abscesses 
of from 4 to 9 centimeters in diameter in other portions of the liver, one 
being situated on the inferior surface. Liver abscesses may vary in size 
from those having a diameter of 1 millimeter or less to the ones which 
fill almost the entire, involved lobe. My records include one in which 
the right lobe was only a shell, containing, at autopsy, over 4 liters 
of fluid. 
Predisposing causes.—Age is a very important factor. It is true that 
amoebic abscesses have been reported in children; Amberg collected 35 
cases of amoebic infection in individuals of this class, with 5 liver ab- 
scesses, and there have been several later reports confirming these results, 
but, at least in the Philippine Islands, it is of very rare occurrence. I 
have not encountered a case among a large number of children under 10 
years of age who have been treated for intestinal amcebiasis, nor has one 
been found during several years of general post-mortem work in this 
country. Old age also seems to be somewhat protective, for my records 
show only one case in a man over 60 years of age. The disease is by far 
the most frequent in young adults and these records bear out the usual 
statement that males are much more often attacked than females. 
Race seems to play an important part in the frequency of this disease. 
Several writers have noted the comparative infrequency of liver abscess 
in natives of the Tropics, and this is emphasized by the conditions in 
Manila. I have not seen an amebic abscess in a Filipino. However, 
a few such cases have been observed by J. R. McDill, R. P. Strong, M. 
Herzog, M. T. Clegg and others in Manila. Intestinal amcebiasis is very 
prevalent among Filipinos. 
The Chinese, owing, no doubt, to their excellent care in food and 
drink, are rarely sufferers from intestinal amcebiasis and, with my 
limited material, no case of abscess of the liver has been found among 
them. 
Alcohol, in my opinion, has been given an overprominent place as a 
predisposing cause of liver abscess and although my statistics are not 
conclusive in this respect, it is certain that many cases are encountered 
among individuals who, without doubt, are non-alcoholics. The unaccli- 
mated are particularly liable to develop the disease and it is believed all 
will concede that very few persons drink less in their home countries and 
during the early days of their stay in the Philippines than they do 
later on. 
