THE PREVENTION OF TROPICAL ABSCESS OF THE LIVER 



BY THE EARLY DIAGNOSIS AND TREATMENT OF 



THE PRESUPPURAT1VE STAGE OF 



AMOEBIC HEPATITIS. 1 



By Leonard Rogees. : 



During the last seven years I have enjoyed most exceptional oppor- 

 tunities for studying tropical abscess of the liver in Calcutta, and have 

 now arrived at the conclusion that the disease can and should be 

 prevented altogether in the great majority of cases. The following are, 

 briefly, the steps by which I have reached this position. 



In 1902 3 I published a paper on tropical or amoebic abscess of the 

 liver and its relationship to amoebic dysentery, in which I gave tables to 

 show that I had found living amoebae in scrapings from the walls of 35 

 out of 37 consecutive liver abscesses, the two negative results being in 

 those livers not examined until twelve or more days after the abscess 

 had been opened and drained. Further, two-thirds of the abscesses, 

 when first opened, were sterile as regards the presence of bacteria. Kruse 

 and Pasquale had previously found amoeba? in only' 6 out of 15 cases of 

 liver abscess. I also showed that when both a clinical history and a 

 post-mortem were available, in 90 per cent of the cases dysentery was 

 found to be associated with the liver abscess, and in 95 per cent of these 

 there was evidence that the dysentery preceded the formation of the 

 abscess, which was always, in my experience, of the amoebic variety. I 

 therefore concluded that the large tropical abscesses (as opposed to those 

 due to suppuration in the portal veins or in the bile ducts) were always 

 due to the Amoeba dy sentence and were secondary to amoebic dysentery, 

 although the latter might often be of a latent nature, giving rise to no 

 typical dysenteric symptoms during life, but revealing itself in the 

 shape of a few amoebic ulcers found post-mortem, usually high up in 

 the large bowel in the caecum or ascending colon. 



1 Read at the Fifth Annual Meeting of the Philippine Islands Medical Asso- 

 ciation, February 29, 1908. 



2 Professor of Pathology, Medical College, Calcutta. 



3 Brit. Med. Journ. (1902), 2, 844. 



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