XII, B. 3 



Abriol: Amcebic Abscess of the Liver 



125 



dysentery or intestinal ulceration by observers in various 

 countries as tabulated by Davidson, (4) appear below. 



Table I. — Association of liver abscess with dysentery or intestinal ulceration. 



Observer. 



1. Annesley 



2. Waring, E 



3. Sanitary Commissioners- 



4. RogrerB — 



5. Sachs 



t. Kartulig 



7. Zancarol 



8. Kelsch and Kiencr 



9. Smith - 



India 



do 



do,-. 



Calcutta 



Egypt -. 



do - 



do— 



Algeria 



Seaman's Hospital . 



Number 

 of cases 

 of ab- 

 scess. 



Cases asso- 

 ciated with 

 dysentery 

 or intesti- 

 nal ulcera- 

 tion. 



29 

 204 

 509 



63 



48 

 500 

 444 

 500 



45 



Per cent. 

 72.3 

 72.2 

 53.0 

 90.48 

 41.7 

 55 to 60 

 59.0 

 85.0 

 84.0 



On the other hand, we cannot overlook the remarks of 

 some of the best observers in the world, who have failed to obtain 

 evidence of a dysenteric or amcebic origin of the disease. 

 Musgrave, in his work on amoeba- and amoebiasis extending for a 

 period of many years, records cases of liver abscess "in which 

 the most careful and persistent search failed to give evidence 

 of a previous dysentery and there was no history of antecedent 

 dysentery or diarrhoea." Morehead(i3) failed entirely to dis- 

 cover any intestinal lesion in 21 of his fatal cases of liver ab- 

 scesses. Kartulis(i3) obtained no history, nor did he discover 

 intestinal lesions in 33.3 per cent of his 33 cases. In 7 out of 

 15 cases Kruse and Pasquale(i3) found no lesions in the bowels 

 and obtained no history of dysentery ; amoebae were not identified 

 in the contents of the abscess. 



With these data before us, we are led to conclude that there 

 are certain forms of amcebic liver abscess intimately associated 

 with intestinal amoebiasis and that there is another form con- 

 stituting a small proportion of all cases, which we may consider 

 as a distinct disease. Musgrave (31) contends that amoebiasis 

 of the liver through any channel other than the bowel seems 

 improbable ; however, if this be admissible, he offers three pos- 

 sible explanations of the apparent primary infection of the 

 liver: (1) Amoebae may reach the liver by the gall ducts; (2) 

 they may penetrate the bowel wall without producing apparent 

 lesions; or (3) the bowel lesions may have been entirely 

 repaired. 



