igio DISEASES OF THE LIVER AND PANCREAS 



The most dangerous time for chills is in the night; therefore it is 

 as well to sleep with some light blanket placed over the abdomen, 

 and in flannel night attire. In the daytime a woollen undervest or 

 cholera-belt may be worn. The clothes must be carefully changed 

 whenever they become damp. 



AMCEBIC ABSCESS OF THE LIVER. 



Synonyms. — Hepatic abscess, French : Ahsces duFoie. Italian: 

 Epatite Suppurativa. German : Tropischer Leberabszess. 



DBfinition. — Amoebic abscess of the liver is a suppurative hepa- 

 titis, caused by Loeschia histolytica — -usually preceded by an attack 

 of amoebic dysentery. 



History, — -Liver abscess was known to the ancients, and was 

 operated upon as far back as the days of Hippocrates, while Galen 

 recognized its connection with dysentery, and Morgagni studied its 

 morbid anatomy. During the nineteenth century the disease was 

 carefully studied by French surgeons, beginning with those of the 

 army of occupation in Egypt, and also by the French colonial 

 doctors and the Indian army surgeons. The discovery of Amcebce or 

 LoeschicB emphasizedthe connection between liver abscess and dysen- 

 tery. Kruse and Pasquale were the first to regularly find amoebae in 

 the liver abscess, and to state that, apart from the amoebae, the pus 

 was sterile. Later researches have confirmed this discovery, and 

 have demonstrated that the pus of a liver abscess does not contain 

 bacteria in most cases — a fact which agrees with our experience — 

 and that the true cause of the malady is Loeschia histolytica. 



Climatology. — Liver abscess is essentially a disease of the tropics 

 and subtropical regions. It is very common in India and Indo- 

 China, rather less so in Ceylon, Malaya, Java, Sumatra, and rare in 

 Southern China. In Africa it is common in Egypt and North and 

 West Africa (Gold Coast). In America it appears to be less com- 

 monly met with, being rare in the United States, West Indies, and 

 British Guiana. It is also found, though rarely, in the Temperate 

 Zone, in Spain, Italy, France, and even in such a northern country 

 as England. There is no seasonal variation. 



etiology. — The cause of the suppuration is Loeschia histolytica, 

 and perhaps other varieties of Loeschice. It is more common in 

 Europeans than in natives, and more so in males than females, 

 and is usually a disease of adults. The most important predispos- 

 ing cause is perhaps alcohol. 



In monkeys one of us has recorded the occurrence of liver abscess due to 

 an amoeba (Lo^scAia wM^^a/^i Castellani, 1907). 



Pathology. — The LoeschicB pass from the bowel via the portal 

 vein into the liver, where they produce coagulative necrosis of the 

 liver cells, which become formless and break up into granular 

 debris. This necrosis is thought to be brought about by means 

 of toxins produced by the LoeschicB. The necrosed area undergoes 

 liquefaction and forms the abscess, the contents of which consist oi 



