HEPATIC ABSCESS 235 



Amoebic dysentery will be fully considered later, with 

 other forms of intestinal disease. Here it is sufficient to 

 state that the disease may be acute, and rapidly fatal 

 perforation in the most severe cases of this form is not 

 uncommon. 



In the common form the onset may be sudden, but 

 more frequently is insidious ; sometimes the patient is not 

 even laid up. It runs a very protracted course : attacks of 

 diarrhoea with the passage of a little mucus and blood, 

 alternating with periods of constipation, when the hard 

 faeces are sometimes coated with blood or mucus, or the 

 stool may be apparently normal. This relapsing, or rather 

 remittent, type of dysentery, for the stools are rarely 

 normal, is usually associated with the amoeba indistin- 

 guishable from A. coli or E. histolytica. Associated with 

 this type of dysentery is hepatic abscess, and rarely 

 abscesses in other organs, such as the spleen. These 

 abscesses are usually sterile as regards bacterial growth, but 

 in the walls of the abscesses the amoebae will be found 

 in abundance. The possibility of this condition must 

 always be considered in any person who has had chronic 

 dysentery, however mild, and in any person from the 

 Tropics with a chronic irregular fever (fig. 66). There 

 is nothing characteristic about the temperature and there 

 may be periods of apyrexia. The liver is enlarged and 

 often tender, but the enlargement is not always marked. 

 Leucocytosis occurs, but may be slight, and is often only 

 to the extent of 12,000 to 15,000 leucocytes. The poly- 

 morphonuclear cells form 75 to 80 per cent, of the total, 

 as a rule. 



Solitary hepatic abscess may occur in England, and in 

 the Tropics, and may be due to other causes, e.g., 

 Ascaris lumbricoides and Clonorchis sinensis. When due 

 to amoebae the associated dysentery may be very mild and 

 in many cases no history of dysentery can be obtained, 

 but in these either amoebae are found in the stools or 

 ulceration of the caecum is found at the post-mortem 

 examination. 



