XII, B, 3 Abriol: Amoebic Abscess of the Liver 131 



only with great difficulty. Reading the results of various 

 observers, we note that there is a discrepancy in results. 

 Waring, (13) in an analysis of 288 cases, found that 61.5 per cent 

 were single; Niblock,(i3) 83 per cent; Rouis,(i3) 75 per cent; the 

 Sanitary Commissioner for India in 509 autopsies in 1896-1901 

 found that only 34 per cent were single. Craig, (18) in an 

 analysis of 24 cases, encountered only 10 single and 14 multiple. 

 In our cases, 6 were multiple and the rest single, the latter giving 

 a percentage of 84. 



SITE 



The majority of our cases are in the right lobe, the upper and 

 lower portions being the favorite seat. Thirty-four cases in- 

 volved the right lobe. Of these, in 2 the left lobe was also in- 

 volved and in 1 case the abscesses were distributed throughout 

 all lobes. Two cases were confined in the left lobe. Of those 

 occurring in the right lobe, 10 were in the superior aspect and 

 11 in the lower part and 13 cases had no definite data as to what 

 part of the right lobe was involved. Rouis,(20) in an analysis of 

 639 cases, gives the occurrence in the right lobe as 70.85 per cent ; 

 in the left lobe as 13.3 per cent; and in the lobus Spigelii as 0.3 

 per cent. Craig, (28) out of 24 cases, encountered 19 in the right 

 lobe, 8 in the left lobe, and 1 in the lobus Spigelii. 



SIZE 



When we bear in mind that some cases of amoebic abscess of 

 the liver may exist in a person, particularly among the natives, 

 without uncomfortable symptoms, the size of the abscess when it 

 comes to the surgeon's hands must of necessity vary. The absces- 

 ses range from 1 millimeter (28) in diameter to one case containing 

 as much as 3,500 cubic centimeters of pus. When multiple, they 

 are generally small. Often two or more abscesses form a single 

 one by confluence. In several of our cases, the abscesses were 

 large enough to yield 2,000 cubic centimeters of pus each. 



CONTENTS OF THE ABSCESS 



The characteristic amoebic pus is diagnostic in itself. Prac- 

 tically in all our cases the pus is viscid and brown in color, 

 resembling thick chocolate. It is odorless and is streaked with 

 blood. The blood may be fresh, being a contamination from the 

 operative incision, or may consist of old clots. Occasionally we 

 may find lumps of translucent mucoid yellowish material which 

 as a rule harbors encysted amoebse. Microscopically the pus is 

 rich in necrotic liver tissue. Leucocytes, red blood cells, and 

 Charcot-Leyden crystals are also found. Unless there exists a 



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