AMCEBIO ABSCESS OF THE LIVER. 221 



number of consecutive fever cases in the Calcutta European Hospital, I 

 realized that the fever of the presuppurative stage of amoebic hepatitis 

 could almost invariably be recognized by the occurrence of a leucoeytosis, 

 usually with no marked increase in the proportion of the polynuclears. 

 I had previously come to the conclusion that active or latent amoebic 

 ulceration of the large bowel always preceded liver complication, and that 

 ipecacuanha is of great value in amoebic dysentery, a point in which 

 Indian experience is at variance with the general opinion in- the Philip- 

 pine Islands, although Simon in New York and Dock in New Orleans 

 are now converts to the view which Sir Patrick Manson and the writer 

 have long advocated. It was but a simple step forward to try the effect 

 of full doses of ipecacuanha in the early stages of amoebic hepatitis, with 

 a view to curing the exciting cause, namely, the ulcers in the large 

 intestine, as had indeed been done empirically many years before by 

 Maclean and Norman Chevers, although with the increasing vogue of the 

 saline treatment in dysentery the use of ipecacuanha had fallen largely 

 out of favor even in the latter disease and had been almost entirely 

 neglected in hepatitis of recent years. I have already published several 

 papers 5 illustrating the marvellous effects of this drug in preventing 

 acute hepatitis passing on to liver abscess, sanctioned even when ex- 

 perienced surgeons were convinced that suppuration had already taken 

 place. A consecutive series will be found in my work on Fevers in 

 the Tropics, while I now have notes of several scores of equally strik- 

 ing cases, which it is unnecessary to relate. It will suffice here to say 

 that during the. last four years no patient has developed an amcebic 

 liver abscess under treatment for hepatitis in the 100 beds for males in 

 the Calcutta open wards of the Calcutta European Hospital, although 

 this was formerly a frequent occurrence, while the number of patients 

 admitted with an abscess of the liver has also fallen considerably. Even 

 more striking evidence of the value of this plan is furnished by the 

 returns of the British army in India, for during the two years which 

 followed the publication of my first series of cases the mortality from 

 liver abscess in English troops in India has fallen by 60 per cent, 

 although stationary for the previous thirteen years. With the wider 

 adoption of this treatment in the earliest stages of tropical hepatitis, 

 *I feel sure even better results will be obtained in the army, as the 

 patients come under skilled medical observation at the beginning of 

 their illnesses. It is already abundantly clear that I did not exaggerate 

 when I wrote that amcebic or tropical liver abscess is an easily prevent- 

 able disease in the great majority of instances, and the occurrence of 

 amoebic suppuration in the liver should cause serious questions in the 

 mind of the medical man in whose hands it has been allowed to develop. 



5 The Therap. Qaz. (1909). 



