AMGEB.E OF THE INTESTINAL TRACT. 161 



as a secondary condition. It should be remembered 

 in this connection that it is not necessary that well 

 marked symptoms of dysentery be present or that 

 the disease be in an acute stage, for many cases may 

 have entirely recovered from the dysenteric symptoms 

 before the abscess of the liver is discovered or has 

 developed. 



The path by which the amoeba? reach the liver 

 from the intestine undoubtedly varies in different 

 patients. They may reach the liver through the blood- 

 vessels, the lymphatics, or through the peritoneum. 

 It is conceded by most authorities that the most 

 probable way is through the portal vein, and in sec- 

 tions of the intestine amoebae are frequently observed 

 lying in close proximity to the capillaries, and in 

 several instances I have observed them actually within 

 the capillaries. Councilman and others consider 

 that the most common way is through the peritoneal 

 cavity and amoebae have been demonstrated in the 

 exudate in peritonitis and in the exudate covering 

 the surface of the liver. This path of infection may 

 explain the location of so many liver abscesses at 

 the upper portion of the right lobe and also the 

 occurrence of superficial abscesses. 



It is very doubtful if infection often occurs by way 

 of the lymphatics, although amoebae are frequently 

 noticed in this location in sections of the intestine. 

 11 



