220 ROGERS. 



Bowel condition in fatal cases of liver abscess. 



Total. Per cent. 



Amoebic dysentery present 35 77.8 



Sears of old dysentery present 20.0 



No evidence of former dysentery 1 2.2 



Evidence of dysentery, always of the amoebic type, is thus seen to be 

 almost constantly found after death from amoebic abscess of the liver, 

 while the few exceptions can readily be explained on the assumption that a 

 mild latent infection had completely healed before death from the hepatic 

 complication, leaving no very evident scarring behind. 



Once more, an analysis of the excellent clinical notes on liver obscess 

 treated in the European General Hospital at Calcutta during the last 

 nine years has furnished the following data : 



Total. Per cent. 



C In hospital 18 "j 



) Within 3 months 10 I 36 72 "\ 



I Over 3 months ago S ) y gg 



Diarrhoea only 7 14 ) 



No diarrhoea 7 14 



There was thus a history of dysentery or diarrhoea in 86 per cent of 

 the cases of liver abscess, while we have already seen that these symptoms 

 may be absent even when amoebic ulceration of the large bowel, commonly 

 limited to the caecum and ascending colon, are actually found post- 

 mortem. 



A further study of the cases in the Medical College Hospital demon- 

 strated that in at least 80 per cent the symptoms of dysentery had 

 preceded the formation of liver abscess, while when the bowel symptoms 

 supervened after signs of acute hepatitis, it is doubtless only a recrudes- 

 cence of old intestinal trouble. 



Eor these various reasons 1 hold that amoebic dysentery, either active 

 or latent, invariably precedes amoebic hepatitis, which is secondary to it 

 by infection through the portal system. In 1903 4 I demonstrated that 

 the earliest minute amoebic multiple abscesses of the liver commence in 

 the terminal branches of the portal veins, and I have several times since 

 found similar small multiple abscesses of the liver containing amoebae., 

 but no bacteria or cocci. 



THE PRESTJPPURATIVE STAGE OF AMCEBIC HEPATITIS. 



The vast majority of patients coming to hospital with an abscess of 

 the liver give a history of fever, with or without pain in the hepatic 

 region, lasting for several weeks and not rarely for several months. They 

 have usually been given quinine and other drugs without avail, the true 

 nature of the disease only becoming apparent with an increased prominence 

 of the localized symptoms. When examining the blood of a large 



'Ibid. (1903), 1, 706. 



