XII, B, 3 Ab7i.ol: Amoebic Abscess of the Liver 127 



In regard to the relationship in point of time between the 

 dysentery and the liver abscess, the majority of observers, 

 namely, Musgrave,(9) Rogers, (22) Manson,(i) Davidson, (4) and 

 many others, believe that dysentery antedates the abscess. 

 However, there are cases on record in which the abscess precedes 

 the dysentery. In all of our cases but one, dysentery antedated 

 the abscess where a history or evidences of intestinal amoebiasis 

 were obtainable. In one case the attack of dysentery started at 

 the same time that the symptoms of abscess formation of the 

 liver began. 



With reference to the existence of amoebae in the stools we 

 have 12 cases in our series in which they were found; of these, 

 9 gave a history of dysentery and 3 denied having had it. 



PREDISPOSING FACTORS 



Race. — Practically all observers agree that amoebic liver ab- 

 scess is more common among foreigners from a cold climate. 

 This fact is hard to explain, especially when we take into con- 

 sideration that the natives are more susceptible to intestinal 

 amoebic infection. Manson,(i) basing his conclusions on army 

 statistics, places the frequency of liver abscess among Europeans 

 as compared with the natives as 95.2 to 4.8 — with amoebic in- 

 testinal infection of 43.8 per thousand in the natives and 28.6 in 

 Europeans. Hence natives are more susceptible to intestinal 

 amoebiasis, but to the hepatic infection they are relatively im- 

 mune, (25) and their immunity diminishes as they come under 

 the influence of urban life. Of 52 cases of amoebic liver abscess, 

 of which I have notes, 38 are Filipinos. The Chinese are much 

 more immune than the natives of the tropics. Musgrave(9) 

 points out that due to their excellent care of food and drink they 

 are immune to amoebiasis. McDill(26) attributes the immunity 

 not only to their habit of eating cooked food, but also to tea 

 drinking. 



Malaria. — Malaria is mentioned in the etiology of amoebic 

 hepatic abscess, yet all authors of textbooks on tropical medicine 

 agree that it has no influence in its causation. In our series, 12 

 had remote histories of malaria, but none of the cases had mala- 

 rial infection at the time of admission to the hospital. 



Vicissitudes of temperature. — Attention has been called to the 

 comparative rarity (4) of liver abscess in countries where there 

 is hot, moist, and equable climate as compared with other 

 countries where the range of temperature is high and the fluctua- 

 tions are sudden. Rogers (22) cites the frequency of chilling 

 causing liver abscess, particularly in individuals who have 



