OF THE ALIMENTARY TRACT 69 



unless there occurs a secondary infection, no active 

 abscess wall formation with conspicuous congestion, 

 leucocytosis or fibrous tissue proliferation. The 

 more chronic, the longer standing, the abscess, the 

 more fibrosis occurs about it. 



The amoebae spread peripherally between the 

 cords of liver cells and as they advance the zone of 

 liver cell degeneration and necrosis progresses until 

 a large abscess reaching the surface may be produced. 

 The extension of the process may lead to rupture 

 into the abdominal cavity or even through the dia- 

 phragm into the chest and lung. Councilman and 

 Lafleur (1891) in a masterly study of the pathol- 

 ogy of amoebic dysentery, which placed intestinal 

 amoebiasis on a definite pathological basis, de- 

 scribe a diffuse degeneration and necrosis of 

 liver cells, especially around the central lobular 

 veins, unrelated to the presence of the amoeba. 

 This they believe to be the consequence of absorp- 

 tion of products of the amoebae in the intestine 

 ulcers. This may be the hepatitis spoken of by 

 clinicians during amoebic dysentery without liver 

 abscess. 



Abscess of the lung by direct extension is the next 

 most common foreign extension, although blood born 

 organisms may be transferred to these organs and to 

 other parts, notably the brain. Wherever the amoe- 

 bae go the characteristic lesion seems to occur; as 

 the organisms spread the tissues become necrotic 

 behind them, liquifying and producing the abscess 



